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Prevention Guidelines for Women 65+

Here are the screening tests and immunizations that most women at age 65 and older need. Although you and your healthcare provider may decide that a different schedule is best for you, this plan can guide your discussion. In addition, major organizations may vary in recommendations on these prevention guidelines.

Screening

Who needs it

How often

Type 2 diabetes or prediabetes

All adults starting at age 45 and adults without symptoms at any age who are overweight or obese and have 1 or more additional risk factors for diabetes

At least every 3 years

Alcohol misuse

All adults

At routine exams

Blood pressure

All adults

Every 2 years if your blood pressure reading is less than 120/80 mm Hg 1

Yearly if your systolic blood pressure reading is 120 to 139 mm Hg or your diastolic blood pressure reading is 80 to 89 mm Hg 1

Breast cancer

All women 2

Yearly mammogram and clinical breast exam 2

Cervical cancer

According to the American Cancer Society (ACS), women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.

Discuss with your healthcare provider 3

Chlamydia

Women at increased risk for infection

At routine exams if at risk

Colorectal cancer

All women of average risk and in good health in this age group, through age 75. For women ages 76 to 85, talk with your healthcare provider about continued screening. For women 85 and older, experts don't advise screening.

The ACS recommends:

Several tests are available and used at different times.

For tests that find polyps and cancer:

  • Flexible sigmoidoscopy every 5 years 4, or

  • Colonoscopy every 10 years, or

  • CT colonography (virtual colonoscopy) every 5 years 4

For tests that primarily find cancer:

  • Yearly fecal occult blood test 5, or

  • Yearly fecal immunochemical test every year 5, or

  • Stool DNA test, every 3 years 5

You will need a follow-up colonoscopy if you choose any test other than a colonoscopy and you have an abnormal result. Screening recommendations vary among expert groups.

Talk with your doctor about which test is best for you.

Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your health history and what colorectal cancer screening schedule is best for you.

Depression

All adults who have access to a clinical practice that has staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up

At routine exams

Gonorrhea

Sexually active women who are at increased risk for infection

At routine exams if at risk

HIV

Anyone at increased risk for infection

At routine exams if at risk

Hepatitis C

Anyone at increased risk; 1 time for those born between 1945 and 1965

At routine exams

High cholesterol and triglycerides

All women ages 20 and older at increased risk for coronary artery disease

At least every 5 years, or more frequently if recommended by your healthcare provider 6

Lung cancer

Adults age 55 to 74 who in fairly good health and are at higher risk for lung cancer defined as current smokers or persons who have quit within past 15 years, and have a 30-pack-year smoking history (Eligibility criteria may vary across major organizations; Age limit may extend to age 80.)

Talk with your healthcare provider for more information.

 

Yearly lung cancer screening with a low-dose CT scan (LDCT)

Obesity

All adults

At routine exams

Osteoporosis, postmenopausal

All women ages 65 and older 7

Bone density test at age 65, then follow-up as recommended by healthcare provider 7

Syphilis

Anyone at increased risk for infection

At routine exams if at risk

Tuberculosis

Anyone at increased risk for infection

Check with your healthcare provider

Vision

All adults 8

Every 1 to 2 years; if you have a chronic disease, check with your healthcare provider for exam frequency

Counseling

Who needs it

How often

Aspirin for prevention of cardiovascular problems

Women ages 55 to 79 when the potential benefits from reducing ischemic strokes outweigh the potential harm from an increase in gastrointestinal hemorrhage

Discuss with your healthcare provider

Diet and exercise

Adults who are overweight or obese

When diagnosed and at routine exams

Fall prevention (exercise, vitamin D supplements)

All women in this age group

At routine exams

Sexually transmitted diseases prevention

All women at increased risk

At routine exams

Tobacco use and tobacco-related disease

All adults

Every exam

Immunization

Who needs it

How often

Tetanus/diphtheria/pertussis (Td/Tdap) booster

All adults

Td: Every 10 years

Tdap is recommended if you are in contact with a child 12 months or younger. Either Td or Tdap can be used if you have no contact with infants.

Chickenpox (varicella)

All adults age 65 and older who have no previous infection or documented vaccinations*

Two doses; second dose should be given at least 4 weeks after the first dose

Flu (seasonal)

All adults

Yearly, when the vaccine becomes available in the community

Hepatitis A vaccine

People at risk 9

Two doses given 6 months apart

Hepatitis B vaccine

People at risk 10

Three doses; second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose)

Haemophilus influenzae Type B (HIB)

Women at increased risk for infection, talk with your healthcare provider

1 to 3 doses

Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)

All adults age 65 and older

1 dose of each vaccine

Zoster

All women ages 60 and older

One dose

1Recommendation from the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure

2American Cancer Society

3The American Congress of Obstetricians and Gynecologists currently recommends that women ages 30 and older get a Pap test once every three years and that women with certain risk factors (or with increased risk) may need more frequent screening. It's reasonable to discontinue screening after three or more consecutive negative Pap tests and no abnormal results within the last 10 years once a woman turns 65 or 70.

4If the test is positive, a colonoscopy should be done

5The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

6Recommendation from ACOG

7Recommendation by the USPSTF

8Recommendation from the American Academy of Ophthalmology

9For complete list, see the CDC website

10For complete list, see the CDC website

*Exceptions may exist; discuss with your healthcare provider

Other guidelines from the USPSTF

Immunization schedule from the CDC

Online Medical Reviewer: Adler, Liora C, MD
Online Medical Reviewer: Cunningham, Louise, RN
Date Last Reviewed: 6/1/2018
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