Monday, May 2, 2016

Screenings You Need and Don’t Need

health screening recommendations for senior citizens

While getting regular tests for certain diseases and medical conditions can prevent health problems down the line,
two tests can do more harm than good.

Many Medicare and other healthcare plans urge their clients, especially older ones, to get regular health screenings, such as colonoscopies. Finding serious medical issues early can mean a longer and healthier life, as well as financial savings for both you and the healthcare plan. Yet, despite all the recommendations, less than 25 percent of Americans ages 50 to 64 and less than half of those over age 65 are up to date on screenings (Next Avenue)

Two Tests to Possibly Avoid

Which tests should you get and which don’t you need? Researchers are questioning the value for older adults of two common tests—mammograms for women and prostate screenings for men. For those who think they have less than five or 10 years to live, it might not make sense to undergo tests that can be uncomfortable or even harmful, and are expensive. For example, men who test high for prostate cancer often have expensive biopsies that can cause infection and pain. If prostate cancer is found, doctors will recommend surgery or radiation therapy that can be painful, even though the slow-growing cancer would not have shortened the patient’s life.

Screenings and ensuing treatment could harm older patients whose health is already fragile, or who have multiple medical conditions. In fact, if the breast or prostate cancer is slow-growing, patients could die from another disease before the cancer affects them.

The U.S. Preventive Services Task Force, an independent panel that weighs evidence and makes recommendations about prevention tests, concluded in 2012 that prostate cancer screening isn’t beneficial at any age and that there’s not enough evidence to know whether women benefit or risk harm by undergoing breast cancer screening after age 74 (from Kaiser Health News)

Yet an article published online in JAMA Internal Medicine in October 2014 shows that many doctors still recommend cancer-screening tests for their older patients. Researchers from the University of North Carolina, Chapel Hill, found that among individuals with the highest risk of dying within nine years, many had undergone cancer screening in the two years before the interview (from Harvard Health Publications).

As mandated by Congress, the U.S. Preventive Service Task Force makes recommendations for 95 screenings that are intended to prevent or reduce the risk for heart disease, cancer, infectious diseases and other conditions. Organizations that focus on one disease or condition, such as the American Cancer Society, have their own recommendations, and different professional organizations, such as the American Medical Association, also make recommendations, which can differ from that of other professional groups.

Common Screenings

The National Institutes of Health and others recommend regular screenings for the diseases and medical conditions listed below. As always, consult with your doctor about whether you need evaluations more often, depending on your risk factors, such as a family history of the disease.

Blood Pressure

Prepare for Health Tests

Before you have a health screening test, ask your doctor these questions:

  • Why do I need the test? What will it show about my health?

  • What will this screening cost, and will my insurance cover it?

  • What do I need to do to prepare for the test? (For example, do I need to have an empty stomach, or will I need to provide a urine sample?)

  • What steps does the medical test involve?

  • Are there any harmful or side effects from this screening?

  • How will I find out the results of my test?

  • How long will it take to get test results?

  • What will we know after the test?

Source: “What Are Health Screenings?,” NIH Senior Health

Every two years, have your blood pressure checked to detect hypertension, which can cause strokes, heart attacks, kidney and eye problems, and heart failure. If the top number (systolic number) is between 120 and 139, or the bottom number (diastolic number) is between 80 and 89 mm Hg (millimeters of mercury, which refers to how high the pressure in the blood vessels pushes a column of mercury) or higher, have it checked every year.

Breast Cancer

Although there’s some debate about when to start mammograms, women over 50 should have them regularly. The American Cancer Society recommends that women ages 45 to 54 get mammograms every year. Women 55 and older can switch to mammograms every two years or can continue yearly screening. But, at 75, women at average risk of breast cancer can stop routine screening.

Cervical Cancer

Women should get a Pap test every three years to test for cervical cancer. If you get a Pap smear coupled with an HPV test, which detects the strains of the virus strongly linked to cervical cancer, you can delay screening to every five years. After 65, you no longer need the test if results in the 10 years prior were normal, according to the American Cancer Society. Once screening is stopped, it should not be started again.

Cholesterol

Your cholesterol should be checked at least every five years, but check it more often if you have high cholesterol, diabetes, heart disease or kidney problems, use tobacco, are overweight or obese, have a personal or family history of heart disease or blocked arteries, or have high blood pressure. High blood cholesterol increases your chance of heart disease, stroke and poor circulation. Ideally, your total cholesterol should be less than 200 mg/dl (milligrams per deciliter). Your HDL (the “good” high-density lipoprotein) should be greater than or equal to 60 mg/dl, and your triglycerides should be less than 150 mg/dl.

Colorectal Cancer

Between the ages of 50 and 75, you should be tested for colon or rectal cancer with either a fecal occult blood test done every year; flexible sigmoidoscopy (a routine outpatient procedure) every five years, along with a fecal occult blood test; or colonoscopy every 10 years. However, if you have risk factors for colon cancer, including ulcerative colitis, a personal or family history of colon or rectal cancer, or a history of large growths called adenomas, you should have the tests done more often. Ask your doctor which test is right for you. If you are between the ages of 76 and 85, talk with your doctor or nurse about whether you should continue to be screened.

Diabetes

If you are age 65 or older and in good health, you should be screened for diabetes (type 2) every three years. If you are overweight and have other risk factors, such as sustained high blood pressure, ask your doctor if you should be screened more often.

Osteoporosis

Women 65 or older should have a bone density test to make sure their bones are strong and to determine whether they are at risk for a fracture. An x-ray of your spine and hip will compare your bone density to that of a young woman in order to estimate your fracture risk. A score above -1 is considered normal; a score between -1 and -2.5 is classified as osteopenia (low bone mass), and a score below -2.5 is considered osteoporosis. While men are not as susceptible to osteoporosis as women, men age 70 and over should consider getting bone mineral density testing.

Prostate Cancer

Prostate examinations are no longer routinely done on men with no symptoms, because the potential benefits of routine screening for prostate-specific antigen (PSA) have not been shown to outweigh the harms of testing and treatment. However, other factors may tip the balance toward regular screening, so men age 50 or older should talk to their healthcare provider about the pros and cons of having their blood tested for PSA levels, which may indicate the presence of prostate cancer.

Other Tests to Consider

Depending on your risk factors, other screenings can be crucial in finding and treating serious health conditions. Talk to your healthcare provider if you feel you are vulnerable in these areas.

C-Reactive Protein

High levels of this protein point to inflammation and could increase your chances of having a heart attack, especially if you have risk factors such as high cholesterol or a family history of heart disease, or if you are overweight. If test results show more than 3.0 milligrams per liter, you are at a higher risk for heart disease and heart attack.

Depression

If you have felt down, sad or hopeless, or if you have little interest or pleasure in life for several weeks, ask your doctor to do a depression screening. This is essentially a series of questions, but your answers will inform your healthcare provider about whether you need treatment.

Hepatitis C Virus

If you were born between 1945 and 1965, have ever injected drugs or have received a blood transfusion before 1992, you should be screened for Hepatitis C, which can lead to liver damage, cirrhosis and cancer. Baby boomers are especially susceptible because of widespread use of recreational (and illegal) drugs during the 1960s and ‘70s. According to studies, boomers are six times more likely to have Hepatitis C than the rest of the population.

Thyroid-Stimulating Hormone

Women over 60 should be tested for an underactive thyroid (hypothyroidism), especially if you feel tired all the time, are more sensitive to cold, have constipation, experience dry skin and are suddenly gaining weight. Your result should be between 0.4 and 4.0 milli-international units per liter (mIU/L).

Vitamin D

Although vitamin D can be synthesized from sunlight, many people are deficient. This vitamin helps keep bones and muscles strong, may help lower your risk for cancer and heart disease, and may boost your immune system. Your test results should be between 20 and 50 nanograms per milliliter (ng/ml).


Sources

“5 Health Tests to Ask the Doctor About,” Dec. 4, 2015, Next Avenue

“Prevention Guidelines for Women 65+,” John Hopkins Medicine

“Many seniors get unnecessary and potentially harmful cancer tests,” Aug. 19, 2014, Harvard Health Publications

“Recommended Screenings for Women 50+,” NIH Senior Health

“What Are Health Screenings?,” NIH Senior Health

“Health screening - men age 65 and older,” Medline Plus

“Report Details Senior Health Care That Misses the Mark,” March 8, 2016, Kaiser Health News

Blog posting provided by Society of Certified Senior Advisors
www.csa.us