Prevention Guidelines for Women 65+

Prevention Guidelines for Women 65+

Here are the screening tests and immunizations that most women at age 65 and older need. Although you and your health care provider may decide that a different schedule is best for you, this plan can guide your discussion.

Screening

Who needs it

How often

Alcohol misuse

All adults

At routine exams

Blood pressure

All adults

Every two years if your blood pressure reading is less than 120/80 mm Hg1

Yearly if your systolic blood pressure reading is 120 to 139 mm Hg or your diastolic blood pressure reading is 80 to 89 mm Hg1

Breast cancer

All women2

Yearly mammogram and clinical breast exam2

Cervical cancer

According to the American Cancer Society (ACS), women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.

Discuss with your health care provider3

Chlamydia

Women at increased risk for infection

At routine exams if at risk

Colorectal cancer

All adults ages 50 and older

The ACS recommends:

For tests that find polyps and cancer:

  • Flexible sigmoidoscopy every 5 years4, or

  • Colonoscopy every 10 years, or

  • Double-contrast barium enema every 5 years4, or

  • CT colonography (virtual colonoscopy) every 5 years4

For tests that primarily find cancer:

  • Yearly fecal occult blood test5, or

  • Yearly fecal immunochemical test every year5, or

  • Stool DNA test, interval uncertain5

The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests. Talk with your doctor about which test is best for you.

Some people should be screened using a different schedule because of their personal history or family history. Talk with your doctor about your history and what colorectal cancer screening schedule is best for you.

Depression

All adults who have access to a clinical practice that has staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up

At routine exams

Diabetes mellitus, type 2

Adults who are asymptomatic and have sustained blood pressure (treated or untreated) greater than 135/80 mm Hg

At least every 3 years

Gonorrhea

Sexually active women who are at increased risk for infection

At routine exams if at risk

HIV

Anyone at increased risk for infection

At routine exams if at risk

Lipid disorders

All women ages 20 and older at increased risk for coronary artery disease

At least every 5 years, or more frequently if recommended by your health care provider6

Obesity

All adults

At routine exams

Osteoporosis, postmenopausal

All women ages 65 and older7

Bone density test at age 65, then follow-up as recommended by health care provider7

Syphilis

Anyone at increased risk for infection

At routine exams if at risk

Tuberculosis

Anyone at increased risk for infection

Check with your health care provider

Vision

All adults8

Every 1 to 2 years; if you have a chronic disease, check with your health care provider for exam frequency

Counseling

Who needs it

How often

Aspirin for prevention of cardiovascular problems

Women ages 55 to 79 when the potential benefits from reducing ischemic strokes outweigh the potential harm from an increase in gastrointestinal hemorrhage

Discuss with your health care provider

Diet, behavioral counseling

Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease

When diagnosed

Tobacco use and tobacco-related disease

All adults

Every visit

Immunization

Who needs it

How often

Tetanus/diphtheria/pertussis (Td/Tdap) booster

All adults

Td: Every 10 years

Tdap is recommended if you are in contact with a child 12 months or younger. Either Td or Tdap can be used if you have no contact with infants.

Measles, mumps, rubella (MMR)

All adults age 65 and older who have no previous infection or documented vaccinations*

One dose

Chickenpox (varicella)

All adults age 65 and older who have no previous infection or documented vaccinations*

Two doses; second dose should be given at least 4 weeks after the first dose

Flu (seasonal)

All adults

Yearly, when the vaccine becomes available in the community

Hepatitis A vaccine

People at risk9

Two doses given 6 months apart

Hepatitis B vaccine

People at risk10

Three doses; second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose)

Pneumococcal (polysaccharide)

All adults

One dose

Zoster

All women ages 60 and older

One dose

1Recommendation from the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure

2Recommendation from the ACS. Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every 2 years for women ages 50 to 74. The ACS recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them. The ACS also recommends annual clinical breast exams (CBEs) for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.

3The American Congress of Obstetricians and Gynecologists currently recommends that women ages 30 and older get a Pap test once every three years and that women with certain risk factors (or with increased risk) may need more frequent screening. It's reasonable to discontinue screening after three or more consecutive negative Pap tests and no abnormal results within the last 10 years once a woman turns 65 or 70.

4If the test is positive, a colonoscopy should be done

5The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

6Recommendation from ACOG

7Recommendation by the USPSTF

8Recommendation from the American Academy of Ophthalmology

9For complete list, see the CDC website

10For complete list, see the CDC website

*Exceptions may exist; discuss with your health care provider

Other guidelines from the USPSTF

Immunization schedule from the CDC

 
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