Table 4. Age 65 and Older

Interventions Considered and Recommended for the Periodic Health Examination  Leading Causes of Death 
Heart diseases 
Malignant neoplasms (lung, colorectal, breast) 
Cerebrovascular disease 
Chronic obstructive pulmonary disease 
Pneumonia and influenza
Interventions for the General Population
SCREENING Injury Prevention,
A. Blood pressure 
A. Pharmacologic treatment for HT (CAN)
B. Lap/shoulder belts 
B.Height and weight, BMI (US) B. Motorcycle and bicycle helmets
A.Fecal occult blood test [1] and/or B. sigmoidoscopy; or (US) colonoscopy q 10 yrs  B. Fall prevention[*] ; legislation, safety aids, stairs, bathtubs
A. Mammogram +/- clinical breast exam [2] (women <=69 yr)  B. Smoke detector[*] (US)
B. Papanicolaou (Pap) test (women)[3] B. Set hot water heater to <120-130 degrees F[*] (US)
B. Vision screening (Snellen) B. CPR training for household members (US)
B. Assess for hearing impairment B. Removal/safe storage of firearms (US)
B. Assess for problem drinking, counsel  Dental Health 
B. Screen for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up
B. Regular visits to dental care provider[*] (US)
B. Screen for osteoporosis in women A. Floss, brush with fluoride toothpaste daily[*]
COUNSELING
Substance Use Sexual Behavior
A. Tobacco cessation; counseling, offer pharmacological therapy. 
B. Consider referral to validated cessation program (CAN)
B. STD prevention: avoid high risk sexual behavior;* use condoms[*]
B. Avoid alcohol/drug use while driving, swimming, boating, etc.[*]  (US) IMMUNIZATIONS
Diet and Exercise B. Pneumococcal vaccine (US)
B. Limit fat & cholesterol; maintain caloric balance; emphasize grains, fruits, vegetables (CAN) B. Influenza [1]
B. Adequate calcium intake (women) (US) B. Tetanus-diphtheria (Td) boosters (US)
B. Regular physical activity (CAN)[*] A. Outreach strategies for influenza vaccination (CAN)
B. Counseling re: sun exposure, clothing (CAN) CHEMOPROPHYLAXIS

A. Discuss aspirin chemoprevention with adults who are at increased risk for coronary heart disease (US) [4]
Framingham 10 year risk:             Date:         ASA discussed? 
Interventions for High Risk Populations
POPULATION  POTENTIAL INTERVENTIONS 
Cardiovascular risk factors/diabetes
 Cardiovascular disease risk factors (US) Consider cholesterol screening
Persons with hypertension or hyperlipidemia Screen for Type II diabetes
 Patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease (US) Intensive behavioral dietary counseling
Adults with BMI >=30 (US) Intensive counseling and behavioral interventions to promote sustained weight loss
Diabetics (CAN) Fundoscopy/retinal photography; microalbumin
Smokers (CAN) Dietary advice on leafy green vegetables and fruits
Men age 65 to 75 who have ever smoked (US) Ultrasound for abdominal aortic aneurysm; surgical repair for aneurysm 5.5 cm or greater
Cancers
Breast Cancer risk >1.66% over 5 years (CAN) Counselling on benefits and risks of using tamoxifen to reduce likelihood of breast cancer
Hereditary Non Polyposis Colon Cancer Family (CAN) Colonoscopy
First degree relative with melanoma (CAN) Physical exam, skin
Family h/o skin cancer; nevi; fair skin, eyes, hair (US) Avoid excess/midday sun, use protective clothing[*]
Infections; vaccinations
Persons susceptible to varicella
Varicella vaccine
Household contact of influenza case Neuraminidase inhibitor prophylaxis if initiated within 36-48 hours of onset in index case
Institutionalized persons (US) PPD ; hepatitis A vaccine ; amantadine/rimantadine
Chronic medical conditions; TB contacts; immigrants; alcoholics; homeless PPD 
Blood product recipients (US) HIV screen ; hepatitis B vaccine; hepatitis C screen (?)
Travelers to developing countries (US) Hepatitis A vaccine ; hepatitis B vaccine
High risk sexual behavior Hepatitis A vaccine ; HIV screen ; hepatitis B vaccine ; RPR/VDRL
Injection or street drug use  PPD ; hepatitis A vaccine ; HIV screen ; hepatitis B vaccine ; RPR/VDRL; advice to reduce infection risk
Health care/lab workers (US) PPD ; hepatitis A vaccine ; amantadine/rimantadine ; hepatitis B vaccine
Osteoporosis/falls
Persons >=75 yr; or >=70 yr with risk factors for falls Fall prevention intervention; multidisciplinary post-fall assessment
Cognitive Impairment
Caregiver or informant description of cognitive
decline; individual's complaint of memory loss (CAN)
Assessment for cognitive impairment
[1] Annually or bienially
[2] Mammogram q1-2 yr, or mammogram q1-2 yr with annual clinical breast exam.
[3] All women who are or have been sexually active and who have a cervix: q<=3 yr. Consider discontinuation of testing after age 65 yr if previous regular screening with consistently normal results.
[4] Balance of benefits and harms most favourable with 10  year Framingham risk greater than 6%
[*] The ability of clinician counseling to influence this behavior is unproven.