Recommended Components of Annual Wellness Exam for an 81-Year-Old Female
For an 81-year-old female, the annual wellness exam should include cancer screening based on her overall health status and life expectancy, with mammography and colorectal cancer screening individualized if she has at least a 10-year life expectancy, while cervical cancer screening should be discontinued if she has had adequate prior screening. 1
Cancer Screening Components
Breast Cancer Screening
- Mammography screening should continue as long as the woman's overall health is good and she has a life expectancy of 10 years or longer 1
- No specific stopping age is recommended, but decisions should be individualized based on health status and longevity 1
- Clinical breast examination may be offered as part of the screening process 1
- Breast self-awareness should be encouraged with prompt reporting of any changes 1
Cervical Cancer Screening
- Women aged >65 years who have had ≥3 consecutive negative Pap tests or ≥2 consecutive negative HPV and Pap tests within the last 10 years (with the most recent test in the last 5 years) should stop cervical cancer screening 1
- Women who have had a total hysterectomy should discontinue cervical cancer screening 1
Colorectal Cancer Screening
- For adults aged 76-85 years, screening decisions should be individualized based on patient preferences, life expectancy, health status, and prior screening history 1
- If screening is continued, options include:
- Adults over age 85 should be discouraged from continuing colorectal cancer screening 1
Lung Cancer Screening
- Annual screening with low-dose helical CT is recommended for adults aged 55-74 years who:
- Are in good health with at least a 30-pack-year smoking history 1
- Currently smoke or have quit within the past 15 years 1
- Have received evidence-based smoking cessation counseling (if current smokers) 1
- Have undergone informed/shared decision making about potential benefits, limitations, and harms 1
- Have access to high-quality lung cancer screening and treatment 1
General Health Assessment
- Complete medical history with focus on family history of cancer 2
- Comprehensive physical examination with attention to:
- Screening for obesity 2
- Screening for elevated blood pressure 2
- Dyslipidemia screening if at increased risk of coronary heart disease 2
- Diabetes screening if sustained blood pressure >135/80 mm Hg 2
Preventive Counseling
- Health counseling regarding:
- Aspirin therapy (75 mg daily) may be considered if benefits of stroke reduction outweigh bleeding risks 2
Cancer-Related Checkup
- Examination for cancers of the thyroid, lymph nodes, oral cavity, and skin 1
- Assessment for symptoms of endometrial cancer if the patient still has her uterus 1
Immunization Status
- Review and update immunizations according to CDC guidelines 2
- Consider influenza, pneumococcal, shingles, and Tdap vaccines as appropriate for age 2, 3
Common Pitfalls to Avoid
- Continuing screening tests when the patient's life expectancy is less than 10 years 1
- Failing to discontinue cervical cancer screening in women who meet criteria for stopping 1
- Ordering unnecessary screening tests without considering potential harms 1
- Overlooking the need for individualized decision-making for adults aged 76-85 years regarding colorectal cancer screening 1
- Neglecting to discuss the benefits and harms of continued cancer screening 1
Special Considerations for Medicare Annual Wellness Visit
- The Medicare Annual Wellness Visit provides a structured opportunity to review preventive health recommendations and screen for geriatric syndromes 4
- Components include health risk assessment, review of functional ability and safety, and establishment of a screening schedule for the next 5-10 years 4
- This visit can be used to address health maintenance gaps such as immunizations and cancer screenings 3