A growing medical consensus says you don’t.
No matter how old you are, it’s important to keep taking some tests – blood pressure check, blood sugar (for Type 2 diabetes), cholesterol, bone density (for osteoporosis) obesity and underweight (for frailty), skin (for cancerous lesions), hearing, vision and balance (for risk of falling), and cognition – at your annual wellness visit.
Past performance is no guarantee of future results, but if your previous results have been trouble-free, you could be better off skipping some of the rest.
Once you’re over 75, some tests have the potential to do more harm than good. Colonoscopy, for example. “As you age, your skin becomes thinner,” says Mayo Clinic geriatrician Paul Takahashi, “so the risk of perforation increases.” And because the procedure involves anesthesia, “patients can sometimes experience confusion or delirium,” he notes. PSA screening for prostate cancer is another test that men over 75 can skip. A positive result can trigger biopsy, followed by surgery and radiation, which can produce unwelcome side effects, such as impaired sexual function.
For all the potential harm, both procedures do little potential good because they test for cancers that grow extremely s-l-o-w-l-y. Intestinal polyps can take as long as ten years to become cancerous, and prostate cancers can be symptom-free for at least a decade. That’s why the U.S. Preventive Services Task Force recommends colonoscopy screenings from age 50 through 75, but optional after that, and against PSA tests after 70.
According to most experts, the Pap smear is a test that most women over 65 can do without. “As women get older, there is less and less cervical cancer,” Dr. Takahashi explains, “and the chances of having it over 65 with numerous negative tests in the past are exceedingly low.”
Biennial mammograms are a tossup; the preventive services task force has no recom-mendations for women over 75. On the one hand, the risk of breast cancer increases with age. But on the other, according to geriatrics professor Christine Kistler (University of North Carolina Medical School), “As women age, you oftentimes will find cancers that will not cause problems. Should we then be subjecting women to surgeries, treatments and their side effects?”
In the end, it all comes down to a decision that you, with the advice of your doctor, make. As Prof. Kistler puts it, “[L]ife is like a prism. We start out with clear light, but end up with different colors. By the time you hit your 70s and 80s, things happen that make you different from others of the same age. More and more, as we get older, we need to individualize medical care.”
I couldn’t agree more – not only about medical care, but also about senior care on the whole.
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