The Aging Emergency Physician: Recommended Health Screenings

As emergency physicians, we are generally aware of recommendations for health care screening, though we may not be personally compliant with them.  As the incidence of many diseases is age-related, we are well-advised to become familiar with some of the major screening guidelines applicable to us.  The following recommendations are based on publications of the US Department of Health and Human Services, in conjunction with a number of major specialty organizations.

1. Cancer Screening:
1. Breast Cancer:  Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.  Clinical breast exams should be part of the periodic health exam every three years for a woman in her 20s and 30s and every year for a woman 40 and over. 
2. Colorectal Cancer:  Beginning at age 50, both men and woman at average risk for developing colorectal cancer should follow one of these five testing schedules:  1) yearly fecal occult blood test(FOBT) or fecal immunochemical test(FIT); 2) flexible sigmoidoscopy every five years; 3) yearly FOBT or FIT plus flexible sigmoidoscopy every five years; 4) double contrast barium enema every five years; 5) colonoscopy every ten years.
3. Cervical Cancer:  The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. Direct evidence to determine the optimal starting and stopping age and interval for screening is limited. Current recommendations are for a screening examination every 3 years until age 65,
4. Prostate Cancer: Both the prostate-specific antigen (PSA) blood test and digital rectal examination should be offered annually, beginning at age 50, to men who have at least a ten year life expectancy.  Men at high risk (African-American men and men with a strong family history) should begin testing at age 45.  Men with multiple first-degree relatives affected should begin testing at age 40.
5. Skin Cancer:  Recommendations vary.  The American Cancer Society advises a skin examination every three years for those 20-39 years of age, and yearly thereafter. 
2. Diabetes:  Recommendations vary. The American Diabetic Association recommends diabetes screening every three years beginning at age 45.   
3. Lipid Disorders:  Men aged 35 years and older and women aged 45 years and older should be routinely screened for lipid disorders and treatment should be instituted for people at increased risk for coronary heart disease. Screenings should include measurement of total cholesterol and high-density lipoprotein cholesterol. 
4. Hearing:  There is currently insufficient evidence to recommend routine screening of adults with audiometric testing.  However,  older adults  should be routinely screened with questions about their hearing.  Anyone reporting hearing loss should have follow-up with appropriate testing.
5. Vision:  The American Academy of Ophthalmology recommends screening for visual acuity and glaucoma by an ophthalmologist every 2-4 years in individuals aged 40-64 years, and every 1-2 years beginning at age 65.  African Americans should begin screenings at age 20 every 3-5 years, and diabetic individuals at any age should have exams at least yearly.
6. Osteoporosis:  Women aged 65 and older should be screened routinely for osteoporosis.  Screening should begin at age 60 for women at increased risk for osteoporotic fractures (ie., lower body weight, no current use of estrogen therapy).
7. Hypertension:  Individuals aged 18 and older should be screened for high blood pressure at least every two years.  Those  with systolic pressures between 120-140 mm Hg, or diastolic blood pressures of between 80-90 mmHg may have pre-hypertension, and should have follow-up examinations.
8. Immunizations:
     Influenza: one dose annually, age 50 and over
     Tetanus, Diphtheria, Pertussis  (Td/Tdap): substitute one dose of Tdap for Td, then Td booster every 10 years.
     Pneumococcal (polysaccharide): one dose, age 65 and over.
     Zoster: one dose, age 60 and over.

 The websites listed below provide a more comprehensive listing of screening recommendation for seniors:

1. US Preventive Services Task Force -  www.ahrq.gov
2. MedlinePlus:Health Screening - http://www.nlm.nih.gov/medlineplus/healthscreening.html
3. American Cancer Society - http://www.cancer.org/docroot/home/index.asp
4. American Diabetes Assn.-  http://www.diabetes.org/  
5. American Academy of Ophthalmology - http://www.aao.org/
6. Immunizations - http://www.cdc.gov/mmwr/PDF/wk/mm5753-Immunization.pdf