by Dr. Yvette Lu.
Last week on Breakfast Television, I reviewed some of the tests that we need to do as we get older.
Here’s the video (5 min):
Since we had limited time on the show, here are more details about what we talked about, plus additional information on items that we didn’t have a chance to chat about during the Breakfast Television segment. Preventive health is very important. It’s probably clear to everyone why! If you catch a disease early, you have a better chance of getting it under control and preventing it from causing significant problems in your body. Here are some of the basic tests we use and discussions we have for health prevention. Some people may need additional tests that I haven’t mentioned here (for example, based on their family history), or they may need tests more frequently that what I’ve written below. This list serves only as general guideline, a gentle reminder, and a starting point for talking to your physician. Care should always be individualized to each person.
- Immunizations (http://www.immunizebc.ca/vaccine-schedules).
- Dental care.
- Vision checks, especially in early childhood, then every 18-24 months, or more frequently if needed.
- Hearing check, especially in early childhood.
- Regular growth checks for height and weight gain.
- Talk to your kids about bullying, school, friends, and their mood, particularly stress, sadness and anxiety. An estimated 1.2 million Canadian children and youth are affected by mental illness, but less than 20 per cent will receive appropriate treatment. If you detect mental illness early, you can address it and possibly prevent it from becoming a lifetime problem.
- Consider checking Iron, especially if diet is unhealthy.
- Consider checking Vitamin D levels, especially if you live in places that are far from the equator (eg. Canada).
- Monitor screen time – no more than 1-2 hours per day for children aged 3-18, and none for children under the age of 2. Excessive screen time can lead to attention problems, obesity, school difficulties, sleep disorders, eating disorders, and risky behaviours. In children under the age of 2, the brain is developing rapidly and it’s best for them to interact with people, not screens.
- Ensure your child gets regular physical activity.
- Immunizations (http://www.immunizebc.ca/vaccine-schedules).
- Regular growth checks.
- Dental care.
- Vision checks, every 18-24 months or more frequently if needed.
- Communication: Stay involved in their lives. Find out what their friends are doing, what pressures they’re facing. Talk to your teens about alcohol, smoking, sex, and drugs. Be a supportive presence. Have family dinners.
- Be aware of potential mood disorders, especially anxiety, depression, and ADHD (Attention-deficit/hyperactivity disorder). 1 out of 7 children and youth in BC are affected by mental illness (about 14%) and 50-70% of mental illness will present before the age of 18. The earlier we detect these conditions, the better the chance we have of treating them successfully.
- Monitor screen time (as described above, aim for less than 2 hours per day) and physical activity levels.
Adults of all ages:
- Immunizations: Tetanus vaccine every ten years, Hepatitis A and Hepatitis B vaccines, Annual Influenza vaccine, Travel vaccinations.
- Blood pressure: check yearly if between 120-139/81-90, every other year if <120/80.
- Check for lipid disorders (high cholesterol) if at increased risk for coronary heart disease (risk factors include: diabetes, family history of heart disease, smoking, high blood pressure, obesity), then every 5 years or sooner based on risk factors
- Check your skin for atypical moles and early signs of skin cancer.
- Body mass index to monitor for obesity.
- Regular Dental Care.
- Health maintenance: regular physical activity, smoking cessation, minimizing alcohol intake, healthy diet.
- Vision checks: Every 10 years until age 40, every 5 years until age 55, every 3 years until age 65, then every 2 years.
- Regular screening for sexually transmitted infections if sexually active and changing partners.
- Calcium and Vitamin D intake to prevent osteoporosis.
Women in their 20s onwards:
- Cervical Cancer Screening: Pap tests to screen for cervical cancer until age 69. BC guidelines: start at age 21 or three years after first sexual contact, then every 1-2 years depending on previous results. Discontinue at 69 if three negative pap tests.
- Folic acid for women planning to get pregnant. Start 2-3 months before you get pregnant. 0.4-1mg for low risk, 5mg if high risk.
- Clinical Breast exams (a breast exam done by a trained doctor or nurse) are optional because evidence has not shown that they reduce mortality. If desired, they can be done every one to three years, then yearly after age 40, or not at all depending on which guideline you follow.
- Breast self exams are no longer recommended, but breast self-awareness is encouraged (recognize the normal appearance and feel of your breasts).
Adults in their 40s onward:
- Most guidelines recommend diabetes screening between the ages of 40-45, or sooner if high risk. This is a blood test, and it should be repeated every 3-5 years or sooner if high risk. If sugars are in the prediabetes range, then they should be checked every year. Canadian guidelines recommend testing based on a risk calculator instead of age.
Women in their 40s onward:
- Breast cancer screening: Between the ages of 40-50, mammograms are optional, and can be done up to every two years. After age 50, mammograms are recommended every 2 years until age 75. For those older than 75 years old, mammograms can be done every 2-3 years depending on health status. Mammograms are recommended yearly starting at age 40 for people with a first degree relative (mother, sister, daughter) with breast cancer. Should you start getting mammograms at age 40? For more insight, watch my 4 minute Breakfast Television chat on mammograms: “The Mammogram Controversy“.
Adults in their 50s onward:
- Colon cancer screening – A stool test to check for blood every 1-2 years or a colonoscopy every 5-10 years depending on your risk level, until age 75. In British Columbia, MSP covers stool screening every 2 years for people at average risk, and a colonoscopy every 5 years for people at higher risk (one first degree relative diagnosed at younger than 60 years old, 2 first degree relatives diagnosed at any age, or a history of adenomas).
- Heart Disease: Talk to your doctor about screening for heart disease to see if you’re at increased risk. Prevalence of heart disease increases after age 45 for men, and after age 55 for women. This involves checking your blood pressure, cholesterol, and talking to you about your risk factors. If you have symptoms and signs of heart disease, your doctor may order additional tests.
Men in their 50s onward:
- Prostate cancer screening: Most guidelines recommend NOT to screen for prostate cancer but there is some disagreement on this topic. The Canadian Task Force for Preventive Health Care and the US Preventive Task Force recommend against PSA screening. The Canadian Urologic Association and Prostate Cancer Canada recommend testing at age 40 if at increased risk, and age 50 at average risk, with optional baseline testing between age 40-49. The American Urologic Association recommends shared decision making starting at age 55. The American College of Physicians recommends initiating discussion at age 50-69, and to screen only if the person has a clear preference for screening. Why are there so many different, and sometimes conflicting, recommendations? The organizations disagree because their decisions are based on different interpretations of the scientific studies used to create the guidelines, and differing perceptions of risk and how prostate cancer is monitored and diagnosed.
Adults in their 60s onward:
- Pneumococcal vaccine is recommended after age 65 (prevents pneumonia caused by pneumococcal bacteria). People with certain chronic diseases can get this vaccine earlier.
- Shingles vaccine is recommended after age 60. You can get it starting at age 50, but it is most effective in people age 60-69, partly because the disease is more common in that age group. Shingles is a painful blistering rash caused by a reactivation of the chicken pox virus. It can cause post-herpetic neuralgia, a condition in which people get chronic nerve pain long after the rash has disappeared. The vaccine reduces the risk of getting shingles by 50%, and reduces the risk of post-herpetic neuralgia by 67%. Protection lasts at least 6 years and the vaccine costs approximately $200.
- Abdominal Aortic Aneurysm screening: An abdominal aortic aneurysm is an enlargement of a section of the aorta, the major blood vessel that supplies blood to the body. The aorta is normally about the thickness of a garden hose. It runs from your heart through the center of your chest and abdomen. Since the aorta is the body’s main supplier of blood, a ruptured abdominal aortic aneurysm can cause life-threatening bleeding. Screening is recommended in males aged 65-75, especially smokers or previous smokers, or people with a positive family history of Abdominal Aortic Aneurysm. Canadian guidelines recommend screening men aged 65-75 regardless of smoking status. For women, the screening decision is based on risk factors (history of smoking, cerebrovascular disease, and family history).
- Osteoporosis screening: Osteoporosis is a bone disease which causes bones to become weak and brittle, leading to an increased risk of fractures after age 65. Screening should start at age 65 with a Bone Mineral Density exam, or sooner if you are at increased risk according to risk calculators.
Adults in their 70s onward:
Adults in their 80s onward:
- Watch for memory loss.
- Social issues: living situation, coping at home, social support, social isolation.
- Mental illness can be common in the elderly and often presents with physical symptoms like fatigue instead of depressed mood.