What are the recommended assessments and interventions for a 75-year-old male undergoing an annual wellness exam?

Recommended Assessments and Interventions for a 75-Year-Old Male Annual Wellness Exam

For a 75-year-old male, the annual wellness exam should include cardiovascular risk assessment, cancer screening, cognitive assessment, and functional evaluation, with screening decisions based on overall health status and life expectancy of at least 10 years.

Cardiovascular Health Assessment

• Blood pressure measurement should be performed annually 1
• Lipid panel screening is recommended for men aged 40-75 years to assess cardiovascular risk 1, 2
• Cardiovascular risk calculation using tools like the ACC/AHA risk calculator to guide statin therapy decisions 1
• Electrocardiogram (ECG) as a baseline assessment for cardiac health 3
• One-time screening ultrasonography for abdominal aortic aneurysm is recommended for men aged 65-75 years who have ever smoked 1, 2

Cancer Screening

• Colorectal cancer screening should continue until at least age 75 for those with life expectancy >10 years, with options including:

  • Annual fecal immunochemical test (FIT)
  • Colonoscopy every 10 years
  • CT colonography every 5 years 1, 2

• Prostate cancer screening should be individualized through shared decision-making:

  • PSA testing should be discussed with men who have at least a 10-year life expectancy 1
  • Digital rectal examination may be considered alongside PSA testing 1
  • For men over 75 years, PSA testing should be approached with caution and only in very healthy men with little comorbidity 1
  • Consider discontinuing PSA screening in men over 75 with PSA levels <3.0 ng/mL 1

• Lung cancer screening with low-dose CT is recommended for men aged 55-80 years with at least a 30-pack-year smoking history who currently smoke or have quit within the past 15 years 1, 2

Cognitive and Mental Health Assessment

• Cognitive screening using validated tools such as the MoCA (Montreal Cognitive Assessment) or other brief mental status tests 1
• Depression screening using standardized tests or conventional mental health interview 1
• Assessment for neuropsychiatric symptoms that may indicate early cognitive impairment 1

Functional Assessment

• Timed gait assessment to evaluate mobility and fall risk 1
• Assessment of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) 1
• Evaluation of motor movements and reflexes 1

Preventive Care and Immunizations

• Vaccination status review and updates according to Advisory Committee on Immunization Practices guidelines, including:

  • Annual influenza vaccination
  • Pneumococcal vaccination
  • Tetanus-diphtheria booster if needed 1, 2

• Lifestyle counseling on:

  • Dietary habits and nutrition
  • Physical activity appropriate for age and health status
  • Smoking cessation if applicable
  • Alcohol use assessment 1

Laboratory Testing

• Complete blood count if clinically indicated 1, 4
• Fasting blood glucose or HbA1c to screen for diabetes 1
• Thyroid function tests if symptoms suggest thyroid disease 3
• Urinalysis if clinically indicated 1

Special Considerations

• Bone density testing should be considered in men aged 75 with risk factors for osteoporosis 1
• Hearing and vision assessment as needed based on symptoms 5, 3
• Discussion about advance care planning and goals of care 1

Important Caveats

• The frequency and extent of testing should be guided by the patient's overall health status and life expectancy 1
• Avoid over-screening in patients with significant comorbidities or limited life expectancy 1
• Many patients expect and value a comprehensive annual physical examination despite evidence suggesting a more targeted approach may be more appropriate 5, 4
• The review of systems and physical examination often have higher therapeutic yield than many routine laboratory tests in detecting clinically important conditions 6