The Medical Tests Older Adults Need

For a longer, healthier life, don’t skip these preventive screenings.

Here’s an important question to ask yourself: Do you want to be that really cool 90-year-old you’ve seen rocking purple hair or running laps around the neighborhood?   

It’s a serious question, says Sterling Ransone, M.D., a family physician in Deltaville, Virginia, and board chair of the American Academy of Family Physicians. “You need to start thinking about how to age successfully,” he says.   

One of the best ways to do that is to make sure you get your preventive screenings. The problem is, less than half of all adults older than 65 are up to date on their screenings, according to the Centers for Disease Control and Prevention. Too many are missing an important opportunity: In one study, people who received regular health screenings were found to have significantly longer life expectancy than those who didn’t.  

That’s not surprising, since “screenings are a way to find a disease that isn’t otherwise evident—and they give us an opportunity to treat it at a stage when it may be easier to manage,” says Sharon A. Brangman, M.D., chair of the department of geriatrics at State University of New York Upstate Medical University in Syracuse.  

So which screenings do you need? The answer depends on your age—and on many other factors, Dr. Brangman says. “Our country’s health care system tends to lump everybody over 65 into one massive group,” she says. “But we’re all so different. You might be an 85-year-old who’s healthy and active, or a 65-year-old who’s frail with multiple medical conditions.”  

Those personal details will affect exactly which tests your doctor recommends and when, but they don’t change the fact that every older adult should take health screenings seriously. Here are seven you need to know about to take charge of your health and catch little problems before they turn into big ones.  

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Preventive Screening #1: Medicare Annual Wellness Visit 

Your annual wellness visit (AWV)—which is free to Medicare beneficiaries—is the best starting point for you and your health care provider to develop a personalized prevention plan based on your current health and risk factors.   

At this appointment, you’ll fill out a health risk assessment (a fancy term for a questionnaire about your health status and family history), review all your current prescriptions, and have your height, weight, and blood pressure checked.  

You’ll also be checked for any cognitive impairment or behavioral health concerns, such as depression or anxiety. Your doctor will consider all this information to identify and address potential problems. Then they’ll give you a list of all the preventive screenings or services you need, which may include some of the items on this list.  

The annual wellness visit is worthwhile no matter how healthy you are today. Here’s what one recent study published in the Journal of Primary Care & Community Health found: People who go to their AWV are 88 percent more likely to also stay up to date on important preventive-care services, including vaccinations and cancer screenings, compared with those who don’t.   

Sound like a lot to manage? Don’t worry—your doctor has you covered. “We try to schedule any follow-up appointments before the patient even leaves the office,” Dr. Ransone says. “We’ve found that if we take care of that at the time of the visit, there’s a much greater chance that people will actually follow through.”  

Preventive Screening #2: Colorectal Cancer Screening 

Colorectal cancer (CRC) is the third-leading cancer killer in the United States, and it’s most common in men and women over 50. But preventive screenings can catch it early, when it’s just starting out as an abnormal growth in your colon or rectum. The earlier the growths are detected, the easier they are to treat—and the better the outcomes.  

Thanks to more CRC screenings in the past decade, new cases have dropped by a lot. But too many people still skip this lifesaving test. In the U.S. today, more than 21 million adults have never been screened for colorectal cancer. Don’t be one of them! 

The tests: There are several kinds, so ask your doctor which one is right for you. Three of the most common include:  

• Colonoscopy. This is the gold-standard CRC screening. It requires a few days of prep and is usually performed while you’re under sedation. The procedure allows doctors to examine all of the large intestine. 
• Flexible sigmoidoscopy. This is a less invasive method with a simpler prep process. It only screens the lower portion of the colon. 
• At-home stool-based tests. These examine a portion of a person’s stool to look for signs of cancer or growths, called polyps.

The timing: Every one to 10 years from age 45 to 75, depending on your medical history and the type of test used.  

Preventive Screening #3: Mammogram 

Since 1990, death rates from breast cancer have fallen by as much as 3.4 percent per year. That means some 600,000 women have avoided losing their lives to this potentially deadly disease.   

Why? Better treatments have helped, but the American Cancer Society attributes much of the improvement to increased mammograms—a screening found to be as much as 80 percent to 98 percent effective at detecting breast cancer.  

The test: A mammogram is an X-ray of your breast, which can find early signs of cancer—sometimes as much as three years before you might notice a lump on your own, according to the CDC.  

Mammograms are typically done at imaging centers, so your health care provider may suggest a specific one they like, or you can find out what facility is part of your insurance network. Alternatively, you can check here to learn more about centers near you.  

The timing: The guidelines for mammograms can vary a little according to different agencies and experts. The American Cancer Society (ACA) suggests starting annual screenings at age 40 and switching to every-other-year from age 55 to 74. After that, the ACA recommends continuing screenings as long as you’re in good health and expected to live another 10 years.

Dr. Ransone offers slightly more nuanced advice: “For women over 50 with average risk—meaning that none of your first-degree relatives, including mother, sister, or daughter, have had breast cancer—the recommendation is to get a mammogram every other year until age 75. If a first-degree relative has had breast cancer, then the recommendation is for yearly mammography.”  

After that, the decision depends on a conversation between you and your doctor. 

Women over 75 with serious health problems, for example, may not be good candidates for more invasive tests (such as biopsies) or surgery should a mammogram find something, Dr. Ransone explains. So continuing with mammograms may not make sense.   

If you’re over 75, “it’s good to be forthright and talk with your provider about the pros and cons,” he says.  

Recommended reading: The 65+ Woman’s Guide to Breast Cancer Screenings

Preventive Screening #4: Sexual Health Screenings 

For anyone—of any age—who is sexually active, screenings are an important way to prevent sexually transmitted infections (STIs). Research shows a recent rise in STIs among older adults. For women, these conditions may not have symptoms, but left untreated they can cause serious problems, including pelvic inflammatory disease. (For men, symptoms tend to appear—and get treated—earlier.)  

Another serious STI: HIV, which can prevent your body from fighting off other diseases. But early detection can keep HIV from developing into AIDS.  

The tests: Simple blood or urine tests are used to detect STIs such as syphilis, gonorrhea, HIV, or herpes.  

The timing: “That depends on the situation,” Dr. Ransone says. “Testing is important for those who may have multiple sex partners.” His recommendation is to have an honest conversation with your doctor about your sexual habits and partners so they can provide the best guidance.  

Preventive Screening #5: Cardiovascular Health Screenings 

The simple truth: The older you get, the greater your risk for cardiovascular disease such as heart attack, stroke, or heart failure. In fact, prevalence of heart disease rises from about 75 percent of people between ages 60 and 79 to nearly 90 percent of people over 80.  

According to the CDC, heart disease is the leading cause of death in the United States, so preventive screenings are super important.   

The tests and timing: Your doctor may recommend certain screenings based on your unique health status and family history, but everyone should be aware of these three important tests:  

• Blood pressure. High blood pressure, or hypertension, can damage your heart and put you at greater risk of a heart attack or stroke. Your doctor will check your blood pressure at least once yearly (as long as you keep up with your annual wellness visits), but some people may benefit from more regular testing. Learn more about how to figure out your ideal frequency here.   

• Cholesterol. Also called a lipid panel, this test measures the amount and types of fat in your blood to estimate your risk of cardiovascular disease. The National Heart, Lung, and Blood Institute recommends annual cholesterol screenings for everyone over age 65.
   
• Abdominal aortic aneurism screening. If you’re a man over 65 who’s ever been a smoker, you should ask your doctor about this ultrasound exam that can catch a potentially deadly heart problem called a dilated artery. It’s typically performed once, at age 65, in male former or current smokers— that is, someone who’s smoked more than 100 cigarettes in a lifetime, Dr. Ransone says. It’s usually covered by Medicare. 

Preventive Screening #6: Bone Density Screenings 

After menopause, women are at greater risk for the bone-thinning diseases osteoporosis and osteopenia. That means that an ordinary tumble could lead to a debilitating fracture. So it’s important to detect thinning bones early, when it’s treatable with medication, diet, and exercise.  

“If we find osteoporosis at 65 rather than at 85, there are effective therapies,” Dr. Ransone says. “And that’s important, because a hip fracture when you’re in your 80s can be deadly.”  

The test: A DXA scan, which is a simple X-ray that takes about 15 minutes.  

The timing: Once, when a woman is 65 and a man is 70. Your doctor may order repeat scans if needed.  

Preventive Screening #7: Lung Cancer Screening

Though cases and deaths from the disease are declining, lung cancer is still the leading cause of cancer deaths in the world. That’s one reason why early detection is critical.

Screenings can reduce lung cancer deaths by 33 percent in women and 24percent in men, according to a randomized trial that looked at more than 15,000 people over 10 years published in the New England Journal of Medicine in 2020. Recently the U.S Preventative Services Taskforce (USPSTF) expanded its screening guidelines to help get more people screened earlier.

Because 80 percent of lung cancer is caused by smoking, it’s smokers and ex-smokers who need to talk about screening with their doctor. The new guidelines lower the age for screening from 55 to 50. Now, anyone who smokes or smoked one pack a day for 20 years or 2 packs a day for 10 years is considered high risk and should ask about lung cancer screening.

The tests: Low-dose computed tomography (LDCT) is used for lung cancer screening. It’s a non-invasive CT scan that works like other CT scans, but with much less radiation.

The timing: The American Cancer Society says a yearly screening may be beneficial. Talk to your doctor for a personalized recommendation based on your individual risk factors.

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