Recommended Health Evaluations and Interventions for a 75-Year-Old Patient
For a 75-year-old patient, comprehensive health evaluations should include cardiovascular risk assessment, medication review, functional assessment, and preventive care interventions tailored to their physiological age rather than chronological age.
Cardiovascular Assessment and Management
- For patients over 75 years with clinical atherosclerotic cardiovascular disease (ASCVD), it is reasonable to initiate moderate or high-intensity statin therapy after evaluating potential benefits, adverse effects, drug interactions, frailty, and patient preferences 1
- For those already on high-intensity statin therapy, it is reasonable to continue after similar evaluation 1
- Hypertension management is crucial, with a target blood pressure of <140/90 mmHg (or <130/80 mmHg for patients with heart failure, renal insufficiency, or diabetes) 1
- Elderly patients often present with atypical symptoms of acute coronary syndrome; active screening should be initiated at lower levels of suspicion than in younger patients 1
Medication Review and Management
- Perform a thorough medication review using validated criteria such as Beers, STOPP (screening tool of older persons' prescriptions), and START (screening tool to alert doctors to right treatment) 2
- For elderly patients on statins, dose selection should be cautious, recognizing the greater frequency of decreased hepatic, renal, or cardiac function, concomitant disease, other drug therapy, and higher risk of myopathy 3
- Monitor all elderly patients on statins for the increased risk of myopathy 3
- Consider potential drug-drug interactions, particularly with commonly prescribed medications in the elderly 1
Functional Assessment
- Assess fall risk with a single screening question: "Have you fallen in the past year?" 2
- Evaluate performance status to determine appropriate treatment intensity for any conditions 1
- Screen for depression when depression care supports are available, using a brief two-item screen like the Patient Health Questionnaire-2 2
- Assess cognition when there is suspicion of impairment 2
- Screen for unintentional weight loss and malnutrition 2
- Assess for urinary incontinence using a two-question screening tool 2
Preventive Care
- Ensure appropriate immunizations are up to date 1
- For patients with diabetes aged >75 years without additional CVD risk factors, consider using moderate-intensity statin therapy and lifestyle therapy 1
- For patients with diabetes aged >75 years with additional CVD risk factors, consider using moderate or high-intensity statin therapy and lifestyle therapy 1
- Smoking cessation interventions should be offered to elderly smokers, as the benefits of quitting in those over 70 are similar to those seen in younger individuals 1
Special Considerations
- Elderly patients (>75 years) often present with atypical symptoms of disease; maintain a high index of suspicion for conditions like acute coronary syndrome 1
- Treatment decisions should be tailored according to estimated life expectancy, patient wishes, and comorbidities 1
- Comprehensive geriatric assessments reveal a large number of previously unrecognized conditions that require further examination and/or treatment, suggesting the need for systematic and regular assessments 4
- Consider physiological age rather than chronological age when making treatment decisions, as people age differently 1
Common Pitfalls to Avoid
- Avoid excessive dosing of antithrombotic agents in elderly patients, which has been observed in registry data 1
- Do not exclude elderly patients from appropriate treatments based solely on chronological age 1
- Avoid assuming that symptoms like shortness of breath, diaphoresis, nausea/vomiting, and syncope are not cardiac-related in elderly patients 1
- Do not overlook the need for medication review, as elderly patients are at higher risk for adverse drug events 2
By implementing these comprehensive evaluations and interventions, healthcare providers can optimize care for 75-year-old patients, improving both quality of life and health outcomes.