Preventive health checklist for seniors

Last year my family doctor sent me for a bone density test. I had it done, then forgot all about it. It wasn't until more than a year later, when I was seeing him for another reason, that I remembered to ask about the test results. They weren't good; I had to go back on bisphosphonates.

My family doctor is savvy and conscientious, but I don't expect him to keep my health record in his head. I realize now that it's my job to provide those reminders. Screening and prevention guidelines often change when you become a senior. I decided I'd better find out what's supposed to happen, and how often. So I found the latest Canadian clinical practice guidelines and came up with the checklist below. I'm not a doctor. If your doctor has a better list, please let me know and I'll update this one. I tried to be thorough, so this blogpost is a big longer and geekier than usual. I didn't list the source documents, but if you want them, just email me through the contact form, and I'll send you the links.

• Annual checkup: No longer routinely provided. Some physicians charge you if you want one.
• Blood pressure: Blood pressure measurement is recommended at all appropriate primary care visits, such as periodic health examinations, urgent office visits for neurologic or cardiovascular issues, and medication renewal visits. It is not necessary to measure the blood pressure of every patient at every office visit.
• Bone mineral density: Men and women over 65 should be assessed for osteoporosis risk, including a bone mineral density test. For patients who are undergoing treatment, repeat measurement of bone mineral density should initially be performed after one to three years; the testing interval can be increased once therapy is shown to be effective. For moderate-risk individuals, a repeat measurement of bone mineral density should be obtained after one to three years to monitor for rapid bone loss. If bone mineral density is stable, then less frequent monitoring can be considered. For individuals with low risk of fracture and without additional risk factors for rapid loss of bone mineral density, a testing interval of 5-10 years may be sufficient.
• Cholesterol testing: A cardiovascular risk assessment, including a blood test, should be completed every 3-5 years for men age 40-75, and women age 50-75 years, and more often for patients at risk. If you are taking statins to control cholesterol levels, your doctor may order blood tests if you are showing possible adverse reactions to the medication.
• Colorectal cancer screening: ColonCancerCheck recommends that all Ontarians aged 50 and over be screened for colorectal cancer. For those at average risk for colorectal cancer, a simple at home test - the Fecal Occult Blood Test (FOBT) - once every two years is recommended. For those at increased risk because of a family history of one or more first-degree relatives (parent, sibling or child) with a diagnosis of colorectal cancer, colonoscopy is advised.
• Diabetes: Fasting blood glucose test at least every 3 years, more often if at risk.
• Flu vaccine: Get it every year.
• Mammogram: Ontario Breast Screening program screens women aged 50 to 74. Women of average risk are usually offered appointments every two years. Screening in women over 75 is individualized based on a woman's overall health, life expectancy and personal preferences.
• Pap test: Every 3 years to age 69. Screening may stop for women aged 70 years and over after 3 successive negative Pap test results.
• Pneumonia vaccine: One dose is recommended for all adults aged 65 and over. Routine reimmunization is not recommended.
• Prostate cancer screening: Prostate cancer screening should be offered to all men 50 years of age with at least a 10-year life expectancy. Annual screening has been the standard; however, recent research suggests that every 2-4 years may be sufficient. Initial screening should include digital rectal examination and prostate-specific antigen testing.
• Shingles vaccine: One dose is recommended for adults 60 and older. The need for revaccination has not yet been defined. The cost is not covered by OHIP.
• Tetanus vaccine: Every ten years.
• Vision screening: For low-risk patients aged 65 and over, at least every 2 years; for high-risk patients, every year. See an eye specialist for this.