Cholesterol Screening Every 5 Years for Elderly Adults
The most likely screening test is A. Cholesterol levels, as this is the only test among the options with a specific guideline-recommended 5-year screening interval for elderly populations focused on reducing cardiovascular mortality.
Rationale for Cholesterol Screening
The USPSTF explicitly recommends cholesterol screening (total cholesterol and HDL) at 5-year intervals for adults, including elderly populations 1. This screening interval is specifically designed to:
- Reduce cardiovascular mortality, which remains the leading cause of death in elderly men and women 1
- Prevent physical disabilities from cardiovascular events like stroke and myocardial infarction 1
- Enhance well-being through early identification and treatment of dyslipidemia 1
The guidelines state that "reasonable options for optimal screening intervals include every five years" for lipid screening, with this interval being appropriate for those without lipid levels close to treatment thresholds 1, 2.
Why Other Options Don't Fit
Digital Rectal Examination (Option B)
- DRE for prostate cancer screening is recommended annually (not every 5 years) beginning at age 50 for men with shared decision-making 1
- DRE for colorectal cancer is performed simultaneously with other colorectal screening methods but is not a standalone screening test with a 5-year interval 1
- This option excludes women entirely, contradicting the question's focus on "elderly men and women" 1
Vision Test (Option C)
- While vision screening is important for elderly populations, no major guideline recommends a specific 5-year interval for vision testing in the provided evidence
- Vision screening intervals are not standardized in the same way as cholesterol screening 3
"Dent" (Option D)
- This appears to be an incomplete or unclear option with no corresponding screening test in clinical guidelines
Clinical Context for Elderly Populations
Cholesterol screening remains valuable in elderly adults despite some nuanced considerations:
- Total cholesterol continues to predict coronary mortality in elderly men, with relative risk of 2.40 for those in the highest versus lowest quintile 4
- The relationship between cholesterol and CHD mortality remains significant in men aged 65 years and older when controlling for other risk factors 5
- Screening may be appropriate in older persons who have never been screened, though repeated screening becomes less important after age 65 as lipid levels are less likely to increase 1
Important Caveats
Treatment decisions must consider overall cardiovascular risk, not lipid levels alone 1. The decision to continue screening in elderly adults should account for:
- Life expectancy of at least 10 years 3
- Overall health status and comorbid conditions 3
- Prior screening history, as those with consistently normal results derive minimal benefit from continued screening 3
Total cholesterol and HDL can be measured on non-fasting samples, making this screening test practical and accessible 1, 2. Abnormal results should be confirmed with a repeat sample, and the average of both results should guide risk assessment 1, 2.