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What You Need, from Pap to Prostate

Coming of Age

By Bob Calandra
WebMD Feature

Reviewed By Michael Smith

As we age, our bodies change and become more vulnerable to illness and disease. No surprise there. But that's why it's important for older adults to receive certain vaccinations, and have regular examinations and tests that focus on specific areas.

For men, crossing the 50-year threshold ought to mean regular screening for colorectal cancer, prostate cancer, and type 2 diabetes, among others. Women need several diagnostic tests throughout their adult lives, but especially after age 40. And older adults in general need to exercise more than most people currently do.

Here, then, is a list of tests, vaccines, and other suggestions commonly recommended by doctors for older adults. The recommendations come from the American Medical Association, the American Cancer Society, and other medical organizations, but are general in nature. Patients always should consult with their doctors to find out what's appropriate for their individual needs.

Vaccinations

The older you get, the more important it is for you to have a yearly flu vaccination. The National Institute on Aging recommends it for those at increased risk for flu complications, which includes those 50 and over.

In addition, the CDC recommends that those 65 and older receive a pneumococcal, or pneumonia, vaccination. The vaccine usually is given as a single dose and is protective for many years. But the CDC suggests that those over 65 have a booster shot if the initial one was five years ago or more.

Exercise

Exercise is good for you, regardless of age. Study after study has shown that exercise helps older adults gain strength, feel better mentally, and improve some diseases and disabilities. Staying physically active also may postpone or limit certain health problems -- heart disease, diabetes, and some types of cancer -- as you grow older.

Skin exam

The American Cancer Society (ACS) recommends a yearly skin examination for anyone age 40 and older. Both the ACS and the American Academy of Dermatology recommend periodic skin self-examination for everyone, concentrating especially on sun-exposed areas.

Cholesterol

A major way to detect and avoid heart disease is to keep an eye on your cholesterol. Older people should be checked at least every three years, assuming their first test is normal. If you are overweight, have diabetes, smoke, or have a family history of hypertension or heart disease, your doctor may check it more frequently. A normal blood cholesterol level, according to the National Cholesterol Education Program, is under 200. A reading between 200 and 239 is borderline high, and anything 240 or above is high.

In addition to total cholesterol, there are various subtypes. High-density lipoproteins (HDLs, so-called "good" cholesterol) help keep the arteries free of plaque.

  • An HDL reading of 60 or above appears to help protect against heart disease.
  • HDL below 40 puts you at risk of heart disease even if your total cholesterol isn't high.

On the other hand, low-density lipoproteins (LDLs, so-called "bad" cholesterol) appear to promote plaque formation. An optimal level of LDL is below 100.

  • Near optimal LDL is 100-129
  • Borderline high LDL is 130-159
  • High LDL is 160-189
  • Very high is 190 and above

If your total cholesterol is high or your HDL (good cholesterol) is low, follow your doctor's recommendations to improve them.

Blood pressure

High blood pressure is a silent killer. That's why everyone should have their blood pressure checked regularly, especially those who are overweight or have diabetes, have a family history of high blood pressure, or are African-American, Puerto Rican, Cuban, or Mexican-American. Left untreated, high blood pressure can lead to stroke, heart attack, and liver, kidney, and eye damage.

Eye exam

The American Medical Association recommends that people ages 40 to 64 get examined by an ophthalmologist every two years for diseases including glaucoma (loss of vision usually related to increased pressure in the eye), macular degeneration (deterioration of the retina), and cataracts (clouding of the eye lens). For those 65 years and older, the AMA suggests an annual exam. Older people with certain risk factors -- including African-Americans (who have a greater risk of glaucoma), a family history of eye disease, or diabetes -- should have a comprehensive eye exam at least once per year regardless of age.

Fasting blood sugar test

Many people aren't aware they have type 2 diabetes, previously known as adult-onset diabetes. That's why the American Diabetes Association (ADA) recommends a fasting blood sugar test every three years for people age 45 and older. Those with risk factors -- including obesity, high blood pressure, or very high blood cholesterol, a family history of diabetes, or are African-American, Native American, or Hispanic -- may need to be tested more often, the ADA says.

Colorectal cancer tests

The American Cancer Society (ACS) recommends that beginning at age 50, both men and women at "average" risk (defined as those with no family history of colon cancer, and no personal history of colon cancer or intestinal polyps) be screened using one of the following acceptable choices:

Electrocardiogram

The American Medical Association recommends having an electrocardiogram every three to five years for anyone with two or more risks for heart disease: a family history of the disease, smoking, high cholesterol, diabetes, or high blood pressure. For older women, menopause means the ovaries stop producing estrogen, which until then appears to help protect them from heart disease. But after menopause, women are as likely as men to have heart attacks.

Osteoporosis

Both men and women can suffer from this bone-thinning condition, although women are more prone to it because they have less bone tissue, and lose bone more rapidly than men because of menopause, according to the National Osteoporosis Foundation. The American College of Obstetricians and Gynecologists recommends that women have a physical exam every year that includes a height check to help detect osteoporosis. There also are bone density tests that can detect it, as well as the rate of bone loss.

Men have larger, stronger bones than women, but two million men have osteoporosis, and another three million are believed to be at risk, says the foundation. White men appear to be most at risk, but osteoporosis can occur in other ethnic groups as well. The foundation says that in general, osteoporosis is underdiagnosed in men and needs further study, and recommends that men talk to their doctors if they notice a loss of height, change in posture, or sudden back pain.

FOR MEN

Prostate exam

There is some difference of opinion here. The American Urological Association and the American Cancer Society say the majority of available evidence suggests that men 50 and older ought to be offered the option of annual testing for prostate cancer. Those tests include a digital rectal exam and a prostate specific antigen (PSA) test, which measures the amount of a certain protein in the blood and can indicate the disease. Men at higher risk, such as African-Americans and those with a family history of early prostate cancer, should start at age 45.

Other scientific and medical institutions, including the CDC, the National Cancer Institute, the American College of Physicians, and the American Society of Internal Medicine, do not currently advocate mass screening or routine screening for prostate cancer.

FOR WOMEN

Pelvic examination and Pap smear

In general, women should have a pelvic exam and Pap smear every one to three years to detect gynecological cancers as well as other conditions. The frequency depends on the results of previous tests as well as each woman's cancer risk factors. Pelvic exams reveal infection, fibroids of the uterus, abnormalities in the cervix, and growths in the ovaries. For women who have had hysterectomies because of cancer, more frequent Pap tests may be recommended. The American Cancer Society says it is incorrect for women to assume they no longer need regular exams just because they've stopped having children.

Breast exam

After age 40, a woman should have a health professional do a breast exam once a year, according to the American Cancer Society. Women of all ages should also perform monthly self-exams and immediately report any unusual changes or lumps they find to their doctor. The best time to do a self-exam is two to three days after your period. Postmenopausal women should pick a day that is easily remembered.

Mammogram

The risk of breast cancer increases as you age, and mammograms can detect cancer or precancerous conditions. The American Cancer Society recommends annual screening mammograms starting at age 40. Some other organizations recommend mammograms every two years. The best time to schedule a mammogram is right after your period ends. Any time is fine for postmenopausal women.

  April 2002

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