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.