What examinations and checks should be performed on clients as a longevity-oriented primary care physician (PCP)?

Longevity-Oriented Primary Care: Essential Examinations and Assessments

Core Annual Laboratory Panel

As a longevity-oriented PCP, you should obtain a comprehensive metabolic assessment annually that includes CBC with differential, comprehensive metabolic panel (CMP), lipid profile (total cholesterol, LDL, HDL, triglycerides), hemoglobin A1C, and urinalysis with albumin-to-creatinine ratio for all adult patients. 1

Standard Laboratory Tests

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 1
• Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 1
• Lipid profile (total cholesterol, LDL, HDL, triglycerides) every 6-12 months for cardiovascular risk stratification 1
• Hemoglobin A1C to screen for diabetes and prediabetes 1
• Urinalysis with albumin-to-creatinine ratio for kidney disease screening 1
• Thyroid-stimulating hormone (TSH) testing, particularly important for women and older adults 1

Risk-Based Metabolic Screening

• For patients with BMI ≥25 kg/m² plus risk factors: Annual diabetes screening with A1C 1
• Risk factors include: first-degree relative with diabetes, high-risk race/ethnicity, cardiovascular disease history, hypertension, HDL <35 mg/dL, triglycerides >250 mg/dL, polycystic ovary syndrome, physical inactivity 1
• For prediabetes (A1C 5.7-6.4%): Yearly testing 1
• For all other adults: Begin testing at age 35, repeat every 3 years if normal 1

Cardiovascular Risk Assessment

Blood pressure measurement should be performed at every visit, with comprehensive cardiovascular risk factor assessment including fasting lipid profile, BMI calculation and plotting, waist circumference measurement, and dietary/activity assessment. 2

Essential Cardiovascular Metrics

• Blood pressure at every visit 3, 1
• Fasting lipid profile with aggressive management of cardiovascular risk factors 2
• Body mass index (BMI) with plotting to track trends 2
• Waist circumference as marker of metabolic syndrome 2
• Abdominal ultrasonography once for men aged 65-75 years who have ever smoked 1

Cognitive and Mental Health Screening

Cognitive screening using validated brief assessment tools such as the MoCA, Mini-Cog, or MMSE should be performed, particularly for patients ≥65 years or those with risk factors, as early detection facilitates planning and intervention. 2, 3

Cognitive Assessment Tools

• MoCA (Montreal Cognitive Assessment): 10-15 minutes, well-suited for detecting MCI, tracks progression through mild to moderate dementia, freely available with training at mocatest.org 2
• MMSE (Mini-Mental State Examination): 7-10 minutes, better for detecting dementia but lower sensitivity for MCI 2
• Mini-Cog, General Practitioner Assessment of Cognition, or Memory Impairment Screen as brief structured assessment alternatives 3

Mental Health Screening

• Depression and anxiety screening using validated tools 3, 1
• Disordered eating patterns screening when appropriate 3, 1
• Sleep disturbance assessment using Mayo Sleep Questionnaire or SCOPA scales, as sleep disorders adversely impact function and may indicate neurodegenerative disease 2

Functional and Geriatric Assessment (Age ≥65 Years)

For patients ≥65 years, functional performance assessment and activities of daily living evaluation are critical components that should not be overlooked, as these identify geriatric syndromes and fall risks amenable to intervention. 3, 1, 4

Essential Geriatric Components

• Functional performance assessment including activities of daily living 3, 1
• Gait and balance evaluation to identify fall risk and need for physical therapy 2
• Sensorimotor examination including assessment for polysensory neuropathy, particularly in feet/legs 2
• Dementia-focused elemental neurologic examination screening for cranial nerve, somatosensory, motor, and postural/gait abnormalities 2
• Bone densitometry for postmenopausal women and men age ≥50 years 1

Cancer Screening

Colorectal cancer screening should begin at age 45 (not 50), with annual breast cancer screening starting 8-10 years after treatment or at age 40 for average-risk women, and shared decision-making discussions about prostate cancer screening for men. 2, 3

Age-Appropriate Cancer Screening

• Colorectal cancer screening beginning at age 45 using FOBT, FIT, colonoscopy, or flexible sigmoidoscopy 2, 3
• Breast cancer screening for women: annual mammography starting at age 40 or 8-10 years after chest/axillary radiation (whichever comes first) 2
• Breast MRI in addition to mammography for women who received chest radiation between ages 10-30 2
• Prostate cancer screening for men using shared decision-making 3
• Thyroid examination yearly for patients with history of neck irradiation 2
• Dermatologic examination yearly, especially for patients with radiation exposure history 2

Medication-Specific Monitoring

Patients on specific chronic medications require targeted laboratory monitoring: vitamin B12 levels for metformin users, and serum potassium for those on ACE inhibitors, ARBs, or diuretics. 1

• Vitamin B12 levels for patients on metformin 1
• Serum potassium for patients on ACE inhibitors, ARBs, or diuretics 1

Preventive Health Counseling and Lifestyle Assessment

At every visit, provide counseling on diet, physical activity, tobacco cessation, and alcohol use as part of health promotion, and address sleep patterns and duration. 3

Essential Counseling Topics

• Diet and nutrition guidance 3, 1
• Physical activity recommendations with no restrictions for most patients 2
• Tobacco cessation counseling 3, 1
• Alcohol and substance use assessment 3, 1
• Sleep patterns and duration 3
• Dietary and activity assessment at least annually 2

Advance Care Planning

Identify surrogate decision maker and discuss advance care planning, including healthcare proxy, living will, and end-of-life preferences, as Medicare specifically requires this assessment. 3

• Healthcare proxy designation 3
• Living will documentation 3
• End-of-life preferences discussion 3

Vaccination Status

Review and update vaccination status according to age-appropriate CDC recommendations, including annual influenza vaccine and pneumococcal vaccination (PPSV23) for patients ages 2-64 years with diabetes or other high-risk conditions. 3

• Annual influenza vaccine 3
• Pneumococcal vaccination (PPSV23) for high-risk patients 3
• Age-appropriate CDC-recommended vaccinations 3

Critical Pitfalls to Avoid

• Never skip cognitive screening even if the patient appears cognitively intact, as Medicare specifically requires this assessment and early detection facilitates planning 3
• Do not overlook functional assessment in patients ≥65 years, as this is critical for identifying geriatric syndromes 3
• Do not delay colorectal cancer screening beyond age 45, as guidelines have recently lowered the recommended starting age from 50 3
• Do not perform unproven screening tests without evidence-based indication, as many PCPs inappropriately order tests like routine complete blood cell counts or urinalysis without specific clinical indication 5