Basic Facts & Information
It is always better to prevent an illness than to treat it after it develops. Some factors that affect your health are outside of your control, such as your age, gender and family history of certain diseases. However, many important risk factors are within your power to change. Steps like screening tests, vaccinations, and healthy lifestyle habits can help prevent many diseases or slow down an illness you may already have. Making small changes in your daily life can help you stay active and independent as you get older. It is never too late to start on the road to better health.
Screening for Common Diseases and Conditions
Below are general recommendations to help prevent illness in older adults. These guidelines can change over time as our understanding of diseases increases. Some screening tests may need to be done more frequently, depending on your specific risk factors. Not every older adult needs all of these tests. Your healthcare provider will work with you to determine which screening tests are likely to benefit you, based on your individual circumstances.
Screening tests may include:
• High Blood Pressure – The chances of developing high blood pressure (hypertension) increase with age. Treating high blood pressure reduces the chance of stroke and heart attack. Your healthcare provider will check your blood pressure at least once a year.
• Weight – Obesity increases the risk of many diseases, including heart disease, diabetes, and some cancers. Excess weight can also make pain from arthritis worse. If you are overweight or obese, your healthcare provider can work with you to reduce your weight to a healthy level to prevent these complications. (However, loss of weight that is not intentional and/or occurs rapidly can also be a sign of poor health.)
• Vision – Seeing well will help keep you active and engaged with family and friends, less likely to fall, and able to enjoy life more fully. You should have your eyes examined by an eye doctor (ophthalmologist) once every year after the age of 65. If you have certain conditions, such as diabetes, you may need more frequent eye exams. The doctor will check for eye diseases that are common in older adults, including:
- Glaucoma – too much pressure within the eye
- Cataracts – clouding of the lens of the eye
- Macular degeneration – loss of central vision
• Hearing – hearing loss can lead to a feeling of isolation and withdrawal from your social life. Modern hearing aids can help make the difference between feeling shut out of life and being part of the conversation again. An audiologist is a healthcare profession who treats hearing loss and other related disorders. An audiologist can check if you benefit from hearing aids, and help with fitting and adjusting hearing aids so that they are comfortable and effective.
• Diabetes – Diabetes is a condition that causes the amount of sugar (glucose) in your blood to be too high. Over time, diabetes can lead to many health conditions, and is a leading cause of blindness, kidney failure, and limb amputations. If you have risk factors for diabetes, such as being overweight, or having high blood pressure or cholesterol, your healthcare provider will do a blood test to screen for diabetes every 1-3 years. After the age of 70, regular screening is not usually recommended.
• Cholesterol – high cholesterol can increase the risk of heart disease and stroke. Screening for high cholesterol is recommended in older adults if they are at increased risk for heart disease because of other risk factors, such as smoking, high blood pressure, or a strong family history of heart disease.
• Osteoporosis – Osteoporosis causes thinning and weakening of the bones that increases the risk of fractures. A bone density scan (a kind of X-ray) is recommended to test for osteoporosis in women 65 or older. (Although men can also get osteoporosis, it is less common than in women. Screening is only recommended in men if they have other risk factors for osteoporosis.)
• Abdominal aortic aneurysm – An abdominal aortic aneurysm is a weakening in the wall of the aorta, the large blood vessel that carries blood from the heart other rest of the body. It causes a bulging of the aorta that can grow over time and may start to leak or even rupture. Screening for abdominal aortic aneurysm (or AAA) is recommended in men age 65-75 who have ever smoked.
• Depression – Depression is common in older adults, but often goes unrecognized. Older people often do not mention symptoms of depression, or may think the symptoms are just a normal part of aging. Depression can also be mistaken for fatigue or some other physical symptom. Your healthcare provider should ask a few questions about your general mood and emotional state at least once a year. If your provider thinks you may be depressed, you may be asked to complete a short questionnaire. Your answers will help you and your provider determine whether you would benefit from treatment, such as talk therapy or counseling, medication, or a combination of both.
• Alcohol use – For people over the age of 65, too much drinking can be harmful. Excessive drinking is considered to be more than three drinks on one occasion, or more than 7 drinks per week. (This is for both men and women.) Excessive drinking increases your likelihood of injuries and accidents, diseases of the stomach, liver and pancreas, and dementia. Your healthcare provider should ask about your alcohol use at least once a year.
• Dementia or cognitive impairment – Although some decline in mental function can occur with age, these normal changes should not get in the way of doing your usual activities. Your healthcare provider will periodically do a short test of your memory and thinking to see if any further testing should be done.
Screening for several types of common cancers is recommended to detect disease early, before there are any signs of symptoms. This is because treatment at an early stage is more likely to be successful. Cancer screening has important benefits, such as finding disease early and preventing deaths from cancer. However, it is important to remember that there are also harms associated with screening tests. These can include complications from the screening test itself, as well as fear and anxiety that could be caused by a false positive test. Screening may also identify a cancer that would never have caused symptoms or death in that person. Treating these cancers with surgery, radiation or chemotherapy can cause harm, without providing any benefit.
People who have a shorter life expectancy due to other illnesses are less likely to benefit from cancer screening tests. It is important to talk with your healthcare provider about whether screening tests for cancer are more likely to benefit or harm you.
The following recommendations are for people at average risk of disease. People at high risk, or with a history of abnormal tests, may need screening earlier and more often.
• Breast cancer – Current recommendations are for women between the ages of 50 and 75 to have a mammogram every two years. Mammograms may be appropriate for women after the age of 75 who are healthy and expected to live for at least 10 more years.
• Colon cancer – There are several tests that can be used to screen for colon cancer. A colonoscopy is the most comprehensive test, and is recommended every 10 years for adults between the ages of 50 and 75. Other screening tests that may be used instead of a colonoscopy include CT colonography (“virtual colonoscopy”) or flexible sigmoidoscopy every 5 years, or testing of a stool sample once a year. Some people age 7-85 may benefit from screening if they are very healthy, or have never been screened. People over age 85 should not be screened.
• Cervical cancer – A Pap smear to test for cervical cancer is recommended for women every 3-5 years. Screening does not need to be continued in women after the age of 65 who have had regular normal screenings in the past 10 years, or in women who have had a hysterectomy for reasons other than cancer.
• Prostate cancer – Screening for prostate cancer has been controversial because the disease usually progresses very slowly, and there is a lack of research to support the benefit of treatment early in the disease. Therefore, screening is no longer recommended for most older men. Your healthcare provider can advise you whether you should be screened for prostate cancer based on your risk factors.
• Lung cancer – Screening for lung cancer with a low-radiation dose CT scan once a year is recommended for people age 55-80 who are at high risk for disease. People at high risk are those who have smoked the equivalent of one pack of cigarettes per day for 30 years, and either currently smoke, or who have quit within the past 15 years.
Because the immune system weakens with age, older adults are at higher risk for many diseases. Some of these common diseases can be prevented with vaccines. The following vaccines are recommended for most older adults. Your healthcare provider can tell you if there are additional vaccinations you should get based on your individual risk factors. In addition, some people cannot get certain vaccinations if their immune systems are severely weakened from medications or other diseases.
• Flu – Up to 70% of hospitalizations and 90% of deaths from the flu occur in older adults. All older adults should get a flu shot every fall, at the start of the flu season.
• Pneumonia – There are two different types of pneumococcal vaccine that are recommended for adults age 65 or older. They are called pneumococcal conjugate vaccine (PCV)13 and pneumococcal polysaccharide vaccine (PPSV)23. Older adults should receive both PCV13 and PPSV23 vaccines, given at least one year apart. Only one dose of each of these vaccines is needed.
• Tetanus, Diphtheria, and Pertussis – Adults should receive a tetanus-diphtheria (Td) vaccine every 10 years. Adults age 65 and over should also receive one dose of the tetanus-diphtheria-pertussis (Tdap) vaccine. The pertussis part of the vaccine protects against whooping cough, so it is especially important for older adults who have close contact with infants under one year of age.
• Singles – Shingles (herpes zoster) is a painful rash caused by the same virus that causes chicken pox. The rash usually appears as band or strip on one side of the face or body. In some people, severe pain can persist even after the rash has healed. This persistent paint is called post-herpetic neuralgia and can last for many years. The risk of both shingles and post-herpetic neuralgia increases dramatically after the age of 50. The shingles vaccine reduces the risk of getting shingles, reduces the severity of shingles outbreaks, and reduces the risk of post herpetic neuralgia. The new herpes zoster subunit vaccine (Zoster Vaccine Recombinant, Adjuvanated) is recommended for adults age 50 and over, even if they have previously had shingles or were previously vaccinated with the live vaccine. The subunit vaccine requires two doses, with the second dose administered 2-6 months after the first dose. People with a history of severe allergic reaction to nay component of the vaccine should not get the shot.
Lifestyle & Management
Stay Healthy and Active Longer
In addition to the screening tests and vaccinations your healthcare provider will do, there are a number of steps you can take to help prevent diseases from developing. Even if you already have an illness, these steps can help keep it from getting worse. For example, sometimes lifestyle changes like eating a healthier diet and exercising more can improve blood pressure or diabetes so that you don’t need to take as much medication.
Stay Healthy by Eliminating Risk Factors for Disease
These major steps can help you stay healthy as long as possible and stop diseases before they start.
Click on the following topics to read more.
Smoking is still the most preventable cause of death in the United States. Quitting can increase life expectancy, lower the risk of heart disease and cancers, and improve lung function and blood circulation. Make a plan for quitting with your healthcare provider. You will have a better chance of quitting if you:
• Set a date for your last cigarette. On that date, get rid of all cigarettes and anything associated with them.
• If you smoke more than 10 cigarettes per day, talk to your healthcare provider about nicotine-replacement therapy, such as a patch, gum, nasal spray or inhaler. This may help reduce physical cravings.
• Talk to your healthcare provider about taking bupropion (Wellbutrin, Zyban), varenicline (Chantix), or similar medications alone or with nicotine replacement therapy.
• Schedule visits with your healthcare provider for reinforcement in quitting
• Join support groups for people trying to quit or get counseling (in a group, individually, or by telephone).
• Avoid people or situations that tempt you to smoke.
• After quitting, switch from coffee and alcoholic drinks to juices or water. Talk walks instead of coffee breaks. Chew gum or suck on hard candy if you have a craving.
• Quitting smoking is hard. Don’t be discouraged if you slip up. Most people who have successfully quit smoking have tried more than once, so don’t give up!
Physical activity is one of the most important ways to remain healthy and independent, and has been shown to help prevent and treat many diseases.
150 minutes of moderate-intensity activity (such as brisk walking) each week. Do aerobic activity in episodes of at least 10 minutes, and spread it throughout the week.
Do muscle strengthening activities (such as lifting weights or using resistance bands or machines) involving all major muscle groups at least two days a week.
If you are not able to meet these goals because of health problems, don’t give up! It is important that you still be as physically active as your abilities and conditions allow. Other special considerations for older adults are:
• If you have fallen, or have a fear of falling, do exercises to maintain or improve balance (such as Tai-chi).
• Understand whether your medical conditions affect your ability to do some activities safely.
If you are just starting an exercise program, or feel overwhelmed and don’t know how to start, your healthcare provider can help you. Your provider can tell you if there are particular types of activity you should do or not do based on your medical conditions, and whether you need any testing of your heart before starting to exercise.
Your provider might have you work with a physical therapist, or recommend group exercise programs. Check to see if your health insurance offers a Silver Sneakers benefit. This program provides access to participating gyms, fitness centers, and classes for older adults.
The more physical activity you can do, the better, but any amount of physical activity is better than none. Physical activity doesn’t have to be strenuous. Walking, cleaning the house, and gardening are all types of exercise you can do. It is never too late to become more physically active and get the health benefits of exercise.
A healthy diet should include lots of whole grains, fresh vegetables and fruit, as well as lean meat and ow-fat dairy foods. Try to avoid foods that are high in salt, fat, or sugar, such as fatty meats, fried food, and processed foods.
There are many reasons some older adults struggle to eat a healthy diet. This can be because of disabilities that make it hard to go shopping or prepare food, an inability to afford healthy foods, dental problems that make it hard to chew, or lack of appetite that can be due to medications or other health problems. It is important for your healthcare provider to know if you have any of these problems, so they can find ways to help.
If you need to lose weight, your healthcare provider can help you develop reasonable goals and plan to achieve them. Your provider may refer you to a dietician or nutritionist as well.
Although moderate alcohol consumption has been associated with some health benefits, almost 15% of older adults drink more than the recommended maximum, which is 7 drinks per week, or more than 3 drinks on one occasion. Older adults can be at increased risk for the harmful effects of alcohol for several reasons. Often older adults have changes in body composition (for example, how much of your weight is fat versus muscle). These changes can cause higher alcohol concentrations in older people compared to younger people with the same dose of alcohol. That means the same drink can affect an older person more strongly than it does a younger person.
Alcohol can interact with many medications, and can worsen a number of medical conditions including high blood pressure, dementia or other problems with memory and thinking, liver disease, and urinary incontinence. Alcohol can cause bleeding in the stomach and sleep problems. It can also affect balance, leading to falls.
Accidents are the 7th leading cause of death among people 65 years and older. Common accidents that can cause injury or death include falls, home hazards, and car crashes.
An unexpected fall can cause serious injury. You could require hospitalization, surgery, care in a rehabilitation facility, or even long-term nursing home care. Such injuries are often the first step in the loss of independent living.
To avoid a fall, ask your healthcare provider how you can lower your falling risk. They will:
• Evaluate your balance, walking ability and speed, bone health, blood pressure, heart health, and look for other physical disabilities
• Check your vision and hearing
• Check your medications and suggest changes if necessary
• Have you see a physical therapist to work on strength and balance
• Recommend a falls-prevention or other exercise program
• Send a professional to check out your home environment and suggest changes (such as installing hand rails and grab bars and bright lighting, and removing loose rugs and electrical cords)
Hazards in your home.
You can reduce your risk of accidental injury by:
• Lowering the water temperature in your hot-water heater to prevent serious burns. It should be no higher than 120 degrees Fahrenheit
• Installing smoke and carbon monoxide detectors
• Installing alarms and automatic shut-off features on appliances like electric kettles
• Removing firearms or making sure they are safely stored
• Knowing how to use any medical equipment in your home, such as oxygen
Your home can be checked for hazards by specially trained occupational therapists or other specialists. Ask your healthcare provider if you think your need someone to check the safety of your home.
Car crashes are the leading case of fatal injuries in adults up to age 75. The crash rate for older drivers is higher than for any other age group except for drivers under 25. To reduce the risk of a car crash:
• Always wear seat belts
• Have regular driving tests
• Take a refresher driving course (available through AARP or the AAA)
• Have your vision checked regularly and wear the right eyeglasses
• Don’t drink and drive
• Don’t use your cell phone or text while you are driving
Knowing when to stop driving altogether is difficult because of the loss of independence. People with severe visual or hearing loss, dementia, seizures, and some other conditions should not drive. Many older adults also reduce their risk by not driving at night, on busy highways, or in bad weather. Your healthcare provider can help connect you with alternative forms of transportation if you need to limit or stop driving.
Unhealthy or missing teeth or diseased gums can make it difficult for you to eat normally and can lead to poor nutrition and malnourishment. Many older adults have dry mouth from medications or lack of hydration. Dry mouth can cause or worsen tooth problems. Visit your dentist at least twice a year to have your teeth and mouth cleaned and examined. Brush and floss regularly. Your dentist may recommend rinses to help with dry mouth, or whether dentures or implants would be helpful for you.
Taking a baby aspirin (81mg) every day has been shown to reduce the risk of having a heart attack in men, and of having a stroke in women. However, even a baby aspirin can increase the risk of serious bleeding, especially in older adults. Taking aspirin to prevent a heart attack or stroke is most beneficial in older adults with other risk factors for heart disease, such as smoking, high blood pressure, or strong family history, and for those who are younger (under age 70). Talk with your healthcare provider about the possible benefits and risks of aspirin given your specific situation.
An annual screening by a skin doctor (dermatologist) is encouraged because of the significant increase in skin cancers in recent decades. Fair-skinned people, and people who have had a lot of sun exposure during their lifetime are at higher risk, but darker skinned people also get skin cancer. These common cancers include basal cell carcinoma (almost always curable) and melanoma (a more serious type of cancer). But do not wait for your annual visit to your dermatologist if you notice:
• Change in size, shape, color, or borders of a mole on your skin
• Change in appearance of your skin in general
• Any new unexplained area of discoloration, scaliness, or roughness
• New appearance of a nodule or pale, sunken area
Limit the amount of time you spend in direct sunlight, and wear protective clothing and sunscreen (at least 30 SPF).