What are appropriate health history and preventive screening questions for a 66‑year‑old woman during her annual physical examination?

Key Questions for Annual Physical Examination in a 66-Year-Old Woman

For a 66-year-old woman's annual physical, prioritize questions about cancer screening history, cardiovascular risk factors, functional status, cognitive health, fall risk, and advance care planning—these domains directly impact mortality and quality of life in this age group.

Cancer Screening History and Status

Breast Cancer Screening

• Ask about her last mammogram and establish annual screening moving forward. Women aged 55 and older should transition to biennial mammography or continue annual screening based on individual health status and life expectancy of at least 10 years 1.
• Inquire about any breast symptoms, family history of breast or ovarian cancer, and previous breast biopsies 1.
• Document whether she performs breast self-examination and when her last clinical breast examination occurred 1.

Cervical Cancer Screening

• Determine if she meets criteria to discontinue cervical cancer screening. Women over 65 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) can stop screening 1.
• Ask about any history of abnormal Pap tests, high-grade precancerous lesions, or cervical cancer, as these require continued screening beyond age 65 1.
• Confirm she has not had new sexual partners, as this does not warrant resuming screening after cessation 1.

Colorectal Cancer Screening

• Ask when she last had colorectal cancer screening and which method was used. At age 66, she should continue regular screening with colonoscopy every 10 years, annual FIT, flexible sigmoidoscopy every 5 years, or CT colonography every 5 years 1, 2.
• Inquire about any family history of colorectal cancer or polyps, personal history of inflammatory bowel disease, or previous abnormal screening results 1.

Lung Cancer Screening

• If she has a smoking history, calculate pack-years and determine eligibility for low-dose CT screening. Women aged 55-74 with at least a 30 pack-year history who currently smoke or quit within the past 15 years should undergo shared decision-making about annual LDCT screening 1, 3.
• Ask about current smoking status, years smoked, and average cigarettes per day 1.

Cardiovascular Disease Risk Assessment

• Obtain history of hypertension, diabetes, hyperlipidemia, and previous cardiovascular events. These are critical for calculating 10-year cardiovascular risk 3.
• Ask about family history of premature coronary heart disease (men <55 years, women <65 years) 3.
• Document current medications, particularly statins, antihypertensives, and antiplatelet agents 3.
• Inquire about chest pain, shortness of breath, palpitations, or claudication symptoms 3.

Metabolic and Endocrine Health

• Ask about symptoms of diabetes including polyuria, polydipsia, unexplained weight loss, and fatigue. Screen with hemoglobin A1C, especially if BMI ≥25 kg/m² with additional risk factors 2.
• Inquire about family history of diabetes and previous glucose testing results 2.
• Ask about symptoms of thyroid dysfunction (weight changes, temperature intolerance, fatigue, hair loss) 1.

Bone Health and Fall Risk

• Assess osteoporosis risk factors including smoking, low body weight, glucocorticoid use, and excess alcohol consumption. These warrant bone density testing even before the standard age of 65 3.
• Ask specifically about falls in the past year—this is the single best predictor of future falls. Inquire about circumstances, injuries sustained, and fear of falling 4.
• Document calcium and vitamin D intake, weight-bearing exercise, and previous fractures 3.
• Ask about balance problems, dizziness, or gait difficulties 4.

Functional Status and Activities of Daily Living

• Inquire about ability to perform basic ADLs (bathing, dressing, toileting, transferring, continence, feeding) and instrumental ADLs (managing finances, medications, transportation, shopping, meal preparation, housework). Functional decline is a key predictor of morbidity and mortality 4, 5.
• Ask about urinary incontinence, which affects quality of life but is often underreported 4.
• Document any mobility aids used (cane, walker, wheelchair) 4.

Cognitive and Mental Health Assessment

• Screen for cognitive impairment with questions about memory problems, getting lost in familiar places, difficulty managing finances or medications, and concerns from family members. Early detection allows for safety planning and advance directive completion 4.
• Ask about depressive symptoms including persistent sadness, anhedonia, sleep disturbances, appetite changes, and suicidal ideation 4.
• Inquire about social isolation, living situation, and availability of social support 4.

Medication Review and Polypharmacy

• Ask her to bring all medications (prescription, over-the-counter, supplements, herbals) or provide a complete list. Polypharmacy is common in this age group and increases risk of adverse drug events 4, 5.
• Specifically ask about use of potentially inappropriate medications in the elderly (anticholinergics, benzodiazepines, NSAIDs) 5.
• Inquire about medication adherence, cost barriers, and understanding of medication purposes 4.

Immunization Status

• Document influenza vaccination (annual), pneumococcal vaccination status (PPSV23 and PCV13), and herpes zoster vaccination. These prevent significant morbidity and mortality 3, 4.
• Ask about tetanus-diphtheria-pertussis booster status (every 10 years) 4.

Health Maintenance and Lifestyle

• Ask about tobacco use and readiness to quit if applicable. Smoking cessation benefits persist even at advanced ages 1, 3.
• Inquire about alcohol consumption using specific quantities (drinks per day/week) 3, 2.
• Document physical activity levels and barriers to exercise 3.
• Ask about dietary patterns, particularly calcium, vitamin D, and fiber intake 1, 3.

Advance Care Planning

• Ask if she has completed advance directives, designated a healthcare proxy, and discussed end-of-life preferences with family. This is a required component of Medicare Annual Wellness Visits 4.
• Inquire about her understanding of life-sustaining treatments and resuscitation preferences 4.

Sensory Function

• Ask about vision changes, last eye examination, and symptoms of cataracts, glaucoma, or macular degeneration. Visual impairment increases fall risk and functional decline 1, 4.
• Inquire about hearing difficulties and use of hearing aids 1, 4.
• Ask about dental health and last dental visit 4.

Family and Social History

• Document detailed family history of cancer (breast, ovarian, colorectal), cardiovascular disease, and other hereditary conditions. Family history is often inadequately documented but critical for risk stratification 1, 5.
• Ask about living situation, caregiver availability, and safety concerns at home 4.

Common Pitfalls to Avoid

• Do not rely solely on medical records for health history—they significantly under-record common health problems in elderly patients, particularly functional impairments and symptoms. Direct patient interview provides better information about illness burden and quality of life 6.
• Do not assume screening should stop at age 65—decisions should be based on life expectancy (at least 10 years) and prior screening history, not age alone 1.
• Do not forget to ask about unexpected vaginal bleeding, as this requires evaluation for endometrial cancer regardless of screening status 1.