Screening Exams for Older Adults

00:01 So, one thing is - we've talked about screening exams.

00:05 Most exams aren't indicative if the life expectancy is less than five years, but I wouldn't just depend - I've got a chart coming up which shows you when to consider stopping these screening tests for cancer.

00:19 But in a very vital patient, don't necessarily think that just because they have reached the age of 75, therefore, it's absolutely the time to stop screening.

00:29 Actually, it may be better to continue to screen those patients.

00:33 And in a patient who is 60, but facing multiple severe illnesses, with a very poor prognosis, they don't necessarily need to go through cancer screening.

00:42 They have enough probably going on in terms of their medical care, just keeping up with appointments for multiple specialists, multiple tests and procedures.

00:51 And therefore, the safe thing is always involve patients and/or their caregivers in decision-making.

00:57 That said, cervical cancer screening, that one is more of a hard-stop just because the risk of cervical cancer among women with previous normal cervical cancer screening tests is very low.

01:08 So, no matter what their level of vitality and their life expectancy is, if they have several normal Pap tests in the past, I generally will stop cervical cancer screening, age 65.

01:21 Age 75 is definitely the year to stop screening for prostate cancer.

01:25 Consideration to stop screening for colorectal cancer.

01:29 You can actually - you can consider stopping breast cancer screening.

01:34 But for a lot of women, they might go through age 80 or even 85 continuing with breast cancer screening.

01:42 So, vaccine is important in the older age group.

01:45 Zoster should be given at age 50 years.

01:47 According to the CDC, adults who are immunocompetent and aged 65 years or older should receive the 20-valent pneumococcal conjugate vaccine (PCV20) or PCV15. If PCV 15 is given, the patient should receive a dose of the pneumococcal polysaccharide vaccine (PPSV23) 12 months later.

02:11 Influenza vaccine annually.

02:13 And continue Tdap vaccine, especially as these older folks are exposed to their grandkids.

02:19 They can either acquire or pass along pertussis.

02:23 And both of those are high risk groups.

02:25 Nobody wants pertussis, so keep the Tdap vaccine going every 10 years.

02:28 Additionally, ensure that patients have received an updated COVID-19 vaccine. Those who are age 60 or older and at high risk for severe respiratory syncytial virus infection may opt to receive the RSV vaccine.

02:44 Shared decision-making is encouraged for these individuals.