As you approach your retirement years, your health needs and concerns may be different from what they were in your 40s and 50s. “Even if you feel fine, you should be regularly screened for a bevy of health issues that you might not have thought about when you were younger,” explains Sandra Fryhofer, MD, an Atlanta internist and spokesperson for the American College of Physicians. Here are the key tests you’ll need to help ensure wellbeing and prevent disease as you get into your 60s and beyond.
Blood Pressure Screenings
About half of American adults have hypertension, or high blood pressure, which puts them at increased risk of heart disease and stroke. “It’s a silent killer, especially among people over the age of 60,” says Fryhofer.
That’s why the US Preventive Services Task Force (USPSTF) recommends yearly blood pressure screenings once you hit age 40. It’s also a good idea to periodically check yours whenever you’re at your local pharmacy, to make sure it’s not creeping up on you, adds Fryhofer. Keeping track of your blood pressure can make you aware of changes over time, as well. Try maintaining a written record or using an app, like Sharecare for iOS and Android.
To note: in 2017, the American Heart Association changed its guidelines to define hypertension as a systolic reading of at least 130 mm Hg or a diastolic reading of at least 80 mm Hg. For seniors, recommendations for blood pressure medications differ depending on your health status, so it’s best to consult with your doctor.
A complete cholesterol test—also called a lipid panel—measures the amount of cholesterol and triglycerides in your blood. It helps determine your risk of plaque buildup in your arteries, which can raise your risk of heart disease and stroke. People with high cholesterol have about twice the risk of heart disease as people with lower levels.
National guidelines recommend getting your cholesterol checked every four to six years starting at age 20, even if you’re otherwise healthy. If yours is elevated, or if you have other health conditions such as diabetes, you may need to be checked more often, says Fryhofer. Despite this, only around 70 percent of US adults reported having their cholesterol checked within the last five years.
Ideally, your total cholesterol should be less than 200 mg/dL, your LDL (“bad” cholesterol) should be under 100 mg/dL, your HDL (“good” cholesterol) should be at least 60 mg/dL, and your triglycerides should be less than 150 mg/dL. However, your doctor will interpret your levels in the context of your overall heart risk.
The good news is: contrary to popular belief, you don’t have to fast for this test, says Michael Hochman, MD, MPH, Director of the Gehr Family Center for Health Systems Science at the Keck Medicine of USC in California. “I’ve had older patients practically pass out on me in the office when they come in, because they’ve been fasting, but research shows that non-fasting results typically differ from fasting results by only a couple points,” he says. If your results are elevated or borderline, your doctor may just have you repeat the test a few weeks later when you are fasting.
Twelve million Americans over the age of 65 have diabetes, two million of whom are undiagnosed, according to the American Diabetes Association (ADA). The USPSTF recommends this screening for anyone aged 40 to 70 who is overweight or obese, and suggests repeating the test every three years if the results are normal. The ADA recommends screening for type 2 diabetes every three years starting at age 45.
Most of the time, if someone doesn’t have any risk factors for diabetes and they are in their 60s, screening them every three years for the disease is fine, says Hochman. But if you have risk factors such as being overweight, having high blood pressure or having a first degree relative (a parent, grandparent or sibling) with type 2 diabetes, you may be screened more frequently.
There are various tests used to diagnose type 2 diabetes including fasting blood glucose, A1C, random blood glucose and oral glucose tolerance tests. The A1C test is often the easiest one to do, since it’s a simple blood test that doesn’t involve fasting, says Hochman, and allows your doctor to get a snapshot of your blood sugar levels over several months.
Colon Cancer Screenings
According to the American Cancer Society (ACS), the third most common cancer found in Americans is colorectal cancer, which is cancer in the colon, rectum or both. The good news is, over the last several decades, death rates have been dropping, thanks in part to better screening methods.
The ACS suggests those at average risk for colon cancer begin screenings at age 45, while other organizations recommend having them by age 50. Based on your preference, this can be:
- An annual fecal occult blood test
- An annual fecal immunochemical (FIT) test
- A stool DNA test (called Cologuard) every 3 years
- Computed tomographic colonography (CTC) every five years
- Flexible sigmoidoscopy every 5 years
- Colonoscopy every 10 years
The advantage to a colonoscopy is its sensitivity and the ability to remove lesions while the procedure is happening. Additionally, if nothing suspicious is found, you don’t have to worry about screening again for a decade, says Hochman. The downside is the unpleasant prep—you have to drink laxatives before the procedure to clean out your colon—as well as a very slight risk of serious complications, such as perforation of your colon or excessive bleeding.
Dental and Vision Exams
One hundred million Americans fail to see a dentist each year, according to the American Dental Association (ADA), even though the organization recommends a dental exam and cleaning at least annually. There’s no one-size-fits-all approach for going to the dentist—some people in their 60s, whose teeth are in good health, can get away with a yearly visit, while others who have developed gum disease may require visits every three to four months. You don’t always need annual dental x-rays, however. If you haven’t had a cavity in a few years and you’re not at high risk for them, the ADA recommends bite wing x-rays every two to three years.
One in three Americans will have a potentially sight-stealing eye disease such as cataracts, glaucoma, diabetic retinopathy or age-related macular degeneration by age 65. If you don’t have symptoms or risk factors for these conditions, the American Academy of Ophthalmology recommends seeing your eye doctor for a complete exam every one to three years from ages 55 to 64, and every one to two years if you’re 65 or older.
Screenings for Smokers
If you have a history of smoking, you should speak to your doctor about lung cancer screening. The ACS and the USPSTF recommend yearly lung cancer screenings with a low-dose CT scan, starting at age 55, for anyone:
- Who currently smokes and has a 30 pack-year smoking history
- Who has quit within the past 15 years and has a 30 pack-year smoking history
A “pack-year” refers to the number of packs smoked per day multiplied by the number of years you’ve smoked; for example, 2 packs per day for 15 years equals 30 pack-years. Depending on the guideline, these screenings may continue up until you’re 80 years old.
The USPSTF also recommends a one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men ages 65 to 75 years who smoke or have smoked. Women who smoke and have a family history of the condition will receive it as part of their first Medicare visit. For men who have never smoked, it depends on risk factors, like family and cardiovascular history, as well as age.
This condition is an enlargement of the aorta, the main blood vessel that delivers blood to your body. It’s very rare, but more common in older male smokers. If the aorta bursts, it can be fatal.
There’s a lot of controversy about the mammogram—a type of low-dose x-ray that screens for breast cancer.
- The USPSTF recommends women between 50 and 74 get one every other year.
- The ACS and the American College of Obstetricians and Gynecologists say either an annual mammogram or one every other year is fine, though women between 40 and 50 should consult their doctor.
- The American College of Radiology recommends having one every year.
“I usually tell my female patients to aim for every year—the reality is women are busy, and more often than not it ends up getting pushed off so it’s every 15 or 18 months or so, anyway,” says Fryhofer. “But if you tell a woman every two years, she might end up stretching it to every three years, which isn’t recommended.”
If you have a family history of breast cancer, or other risk factors for the disease, talk to your doctor about whether it makes sense to have more frequent screenings, or an MRI screening to supplement your mammography.
Most women still need to be screened for cervical cancer until they turn 65. You have one of three options: a Pap smear every three years, an HPV test every 5 years, or a combination of Pap and an HPV test every five years. (HPV is the virus that causes cervical cancer.) You can stop after age 65 if you don’t have a history of cervical cancer, if you’ve had regular screenings and if you’re not at increased risk.
All women should be screened for osteoporosis starting at age 65, according to the USPSTF. The condition occurs when your body loses too much bone, increasing risk for fracture. You may need to be screened earlier if you have risk factors—like smoking or diabetes—or if you’re on medications that can cause bone loss, such as long-term use of the steroid prednisone.
If your results are normal, you won’t need a repeat scan for 10 to 15 years, but if your scan shows mild bone loss (osteopenia) you’ll need a follow up scan in 3 to 5 years. For more serious bone loss, you may be screened every two years.
Osteoporosis screening isn’t recommended for men in their 60s unless there’s evidence they’ve lost bone mass already—or they have risk factors, including hyperthyroidism and certain intestinal problems. In these cases, men should talk to their doctor about screening, adds Fryhofer.
To screen men for prostate cancer, doctors use the PSA blood test, which measures a specific protein made by the prostate gland. Groups like the USPSTF and the American Urological Association say that the screening decision should be an individual one, and suggest all men between the ages of 55 and 69 have a discussion about the pros and cons of the test with their doctor.
Most of the time, it’s not needed, says Hochman, unless you’re already at high risk for prostate cancer due to a family history or being African American. “The concern here is the risks of the test outweighs its benefits,” says Hochman. “It has a high rate of false positives, which can lead to unnecessary worry and treatments that may be more harmful than the disease.”
Testing for Sexually Transmitted Infections
Many older adults don’t even think about it, but if you’re not in a monogamous relationship or you have multiple sexual partners, you should be screened for HIV just like a younger person with risk factors, advises Hochman. Regardless, it’s recommended that all people over the age of 60 have a one-time HIV test if they haven’t been previously tested. Women or men with risk factors for sexually transmitted infections should also be tested for chlamydia and gonorrhea.
Anyone born between 1945 and 1965 should also have a one-time hepatitis C screening, as they are five times more likely to have the condition than other adults. While hep C can be transmitted sexually, the reason for this screening is related to something else entirely: baby boomers may have become infected from medical equipment or procedures before universal precautions against the virus were put into effect.
Vaccines are crucial for people over the age of 60, because as you get older, your immune system weakens and it’s harder to fight off infections. These include:
- An annual flu vaccine: Over 60 percent of seasonal flu-related hospitalizations occur in people 65 years and older, according to the Centers for Disease Control and Prevention (CDC).
- Pneumococcal vaccine: It’s recommended for all adults over age 65, and those younger with certain health conditions such as diabetes. Two vaccines protect against pneumococcal disease—PCV13 (Prevnar 13) and PPSV23 (Pneumovax 23). The CDC recommends that all adults 65 and older have both shots, a year apart, with the PCV13 first.
- Shingles vaccine: Almost one out of every three people in the US will develop shingles—a painful reactivation of the chickenpox virus in your body—during their lifetime, and your risk increases as you age. A new shingles vaccine, Shingrix, was approved by the FDA in 2017. The CDC recommends anyone over age 50 get this immunization, which requires two doses a few months apart. It’s 97 percent effective for adults in their 60s.
- Tetanus, diphtheria and pertussis (Tdap) vaccine: If you’ve never received a Tdap vaccination—or you’re not sure—you should receive a three-part series of tetanus and diphtheria (Td) vaccines. If you did have a Tdap, you still need a Td booster every 10 years.
Sourcing: CDC, U.S. Preventive Services Task Force, American College of Cardiology, American College of Physicians, Journal of the American Medical Association, American Diabetes Association, American Academy of Family Physicians, American Cancer Society, American Dental Association, American Optometric Association, The American College of Gynecologists, Journal of the American College of Radiology