What routine screenings are recommended for elderly individuals over 75 years old?

Routine Screening for Elderly Adults Over 75 Years Old

For adults over 75 years old, routine screening should be highly individualized based on life expectancy and prior screening history, with most cancer screenings discontinued except in those with >10 years life expectancy who lack adequate prior screening, while cardiovascular risk factor monitoring and diabetes/cognitive screening should continue.

Cancer Screening

Colorectal Cancer

• Adults aged 76-85 years should have screening decisions individualized based on patient preferences, life expectancy, health status, and prior screening history 1
• Individuals over age 85 years should be discouraged from continuing colorectal cancer screening 1
• The rationale is that modeling data show minimal incremental benefit that is unlikely to outweigh harms, especially among those with prior screening 1
• A healthy 76-year-old who has never been screened may still benefit from screening, whereas one with regular normal screening may reasonably discontinue 1
• The average time to prevent 1 death from colorectal cancer is 10.3 years, which exceeds average life expectancy for most adults over 75 1

Breast Cancer

• Women aged ≥55 years should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer 1
• Screening can transition to biennial intervals or continue annually based on patient preference 1
• Medicare covers annual screening mammography for women older than age 40 1

Cervical Cancer

• 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 occurring in the last 5 years, should stop cervical cancer screening 1, 2
• Women who have not been previously screened or lack documentation of adequate prior screening should continue screening beyond age 65-70 2
• Once screening is discontinued, it should not resume for any reason 2

Prostate Cancer

• Men should have shared decision-making discussions about prostate cancer screening that weigh potential benefits against harms, considering life expectancy 1, 3
• Medicare covers annual digital rectal examination and PSA testing in men older than 50 years 1

Metabolic and Cardiovascular Screening

Diabetes Screening

• Annual screening for cognitive impairment is indicated for adults 65 years of age or older 1
• Screening tools include Mini-Mental State Examination, Mini-Cog, and Montreal Cognitive Assessment 1
• Diabetes screening with hemoglobin A1C should continue, especially for those with BMI ≥25 kg/m² with additional risk factors 3
• For those with normal results, repeat testing every 3 years is appropriate 3, 4
• However, evidence suggests that screening non-obese elders age >75 years with fasting glucose <100 mg/dL may not be necessary every 3 years 5

Cardiovascular Risk Factors

• Blood pressure measurement should occur at every visit 1, 3
• Lipid profile screening should continue with intervals based on clinical judgment 1, 3
• The optimal screening interval is uncertain, but screening every 5 years may be reasonable 1

Cognitive Screening

• Annual screening for mild cognitive impairment or dementia is indicated for adults 65 years of age or older 1
• This is critical because cognitive impairment affects diabetes self-management and increases hypoglycemia risk 1
• Screening should use validated tools such as Mini-Mental State Examination or Montreal Cognitive Assessment 1

Laboratory Monitoring

Routine Laboratory Tests

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 3
• Comprehensive metabolic panel (CMP) to assess kidney and liver function 3
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 3

Hypoglycemia Assessment

• Older adults should be routinely queried about hypoglycemia episodes at every visit 1
• Hypoglycemia should be avoided and managed by adjusting glycemic targets and medications 1

Key Considerations for Adults Over 75

Life Expectancy Threshold

• The critical decision point is whether life expectancy exceeds 10 years 1
• Among 75-year-old men and women in the United States, average life expectancy is 9.9 and 12 years, respectively 1
• Those with serious comorbid conditions have even shorter life expectancy and are unlikely to benefit from cancer screening 1

Prior Screening History

• Prior screening history is essential in determining whether to continue or discontinue screening 1, 2
• Those with consistently normal prior screening results derive minimal benefit from continued screening 1

Common Pitfalls to Avoid

• Do not continue routine colorectal cancer screening in adults over 85 years 1
• Do not fail to document adequate prior screening history before discontinuing cervical cancer screening 2
• Do not neglect annual cognitive screening, as cognitive impairment significantly impacts diabetes management and hypoglycemia risk 1
• Do not assume that screening benefits outweigh harms in those with limited life expectancy or multiple comorbidities 1