Yearly Checkups for Seniors

The annual comprehensive physical examination has become a fixture of the American medical practice since the 1940s.

The need for an annual check-up becomes all the more important as you get older to reduce your risk of avoidable diseases and injuries. However, many people are unclear about what this involves and may confuse a traditional physical exam with an Annual Wellness Visit (AMV) offered by Medicare.

The AMV, fully covered by Medicare providers, involves an evaluation of your height, weight, and blood pressure; a review of your prescriptions and medical and family history; and a screening checklist outlining the preventive services you need (like vaccinations or mammograms).

Despite the benefits of wellness checks, most health authorities recommend a far more comprehensive evaluation, involving tests and procedures that may not be fully covered by Medicare.

This article offers the current recommendations for annual physical examinations in older adults, including some tests or procedures that may be added based on your sex and individual risk factors.

Recommended Routine Tests for Everyone

The U.S. Preventive Services Task Force (USPSTF) is an independent panel of experts funded by the U.S. Department of Health and Human Services that issues recommendations for medical screenings to better prevent disease and illnesses in adults and children.

Their recommendations largely form the backbone of what is involved—but not necessarily covered—in an annual comprehensive physical exam.

The USPSTF currently recommends the following for all adults over age 50 as part of an annual physical exam:

• Blood pressure reading: Knowing if your blood pressure is high, normal, or low can help predict your risk for coronary artery disease (CAD) and other medical condtions.
• Height and weight: A measurement of your height and weight is used to calculate your body mass index (BMI), which determines if you are underweight, normal weight, overweight, or have obesity. This can help inform your risk of many health condtions.
• Lipid panel: This panel of blood tests measures your cholesterol and triglyceride levels. The results can inform your risk of heart attack and stroke.
• Fasting blood glucose (FBG) test: This is only recommended for people who are overweight or have obesity (but can be offered as a part of a routine panel of blood tests). The test measures your blood sugar and helps establish your risk of type 2 diabetes.
• Depression screening: This is a questionnaire designed to check if you are at risk or have symptoms of depression.

The following tests and procedures are recommended every one to 10 years. Some may be added to your annual physical exam, and you may receive a referral to follow up with others:

• Colorectal cancer screening: This may involve colonoscopy (performed every 10 years), sigmoidoscopy (every five years), Cologuard (every three years), and fecal occult blood testing (every year).
• Hepatitis C screening: One-time testing for hepatitis C is recommended for all adults 18 to 79 years. Early diagnosis and treatment reduce the risk of hepatitis complications like cirrhosis.
• HIV testing: One-time testing is recommended for all people ages 15 to 65 as part of a routine healthcare visit. Early diagnosis and treatment can keep you healthy for many years.
• Syphilis screening: This is recommended for anyone who may be at risk of getting this sexually transmitted infection (STI) irrespective of age. This is especially true for sexually active men who have sex with men (MSM), who are at increased risk.
• Lung cancer screening: Annual screening with low-dose computed tomography (CT) is recommended for adults 50 to 80 years who have a 20 pack-year (PPY) history of smoking and either currently smoke or have quit within the past 15 years.
  

Recommended Tests for Females

Depending on your sex assigned at birth, there may be additional tests that you should undergo. For people assigned female at birth. this may include:

• Pelvic exam: The American College of Obstetricians and Gynecologists (ACOG) recommends pelvic exams only when you have symptoms or a medical history of gynecological conditions.
• Mammogram: USPSTF recommends a mammogram every two years between the ages of 50 and 74 to check for signs of breast cancer.
• Pap smear: Between ages 30 and 65, a Pap smear is recommended every three years to check for signs of cervical cancer (or every five years if a pap smear is accompanied by human papillomavirus (HPV) testing). After 65, pap smears may not be needed if your results have been consistently normal and you have no risk factors for cervical cancer.
• Bone mineral density screening: The USPSTF recommends a DEXA scan to check for osteoporosis (porous bones) in females 65 years and older. For those younger than 65, screening may be indicated if they have risk factors for osteoporosis.

Recommended Tests for Males

There are also certain tests recommended for people assigned male at birth that may be periodically added to the annual physical exam:

• Prostate-specific antigen (PSA) testing: This blood test detects signs of prostate gland inflammation which, at certain levels, may suggest prostate cancer. Because the results are non-definitive, the USPSTF advises males aged 55 to 69 to discuss the benefits and drawbacks with their healthcare provider based on their risk factors and individual circumstances.
• Digital rectal exam (DRE): This is a procedure in which a gloved finger is inserted into the rectum to check for signs of prostate cancer. There are no clear recommendations for when a DRE is needed, but it can be used with a PSA based on a discussion with your healthcare provider. In some cases, a DRE may find a tumor even when the PSA is normal.
• Abdominal aortic aneurysm screening: The USPSTF recommends one-off screening with ultrasound in males 65 to 75 years who have never smoked. An abdominal aortic aneurysm is the bulging of a blood vessel called the aorta that can be life-threatening if it bursts.
  

Addressing Other Health Concerns

During your check-up, our healthcare provider will want to ensure that your vaccinations are up to date, including the following recommended for adults ages 65 and over:

• Influenza (flu)
• COVID-19
• Pneumococcal pneumonia
• Shingles
• Tetanus and pertussis

The vaccine for respiratory syncytial virus (RSV) should also be considered for people 60 and older after discussion with your healthcare provider.

If you have diabetes, your healthcare provider should examine your feet for signs of diabetic ulcers, and your eyes for signs of diabetic retinopathy.