Prevention Guidelines for Women 65+

July 25, 2018

Prevention Guidelines for Women 65+

Here are the screening tests and immunizations that most women at age 65 and older need. Although you and your healthcare provider may decide that a different schedule is best for you, this plan can guide your discussion.

Screening	Who needs it	How often
Type 2 diabetes or prediabetes	All adults beginning at age 45 and adults without symptoms at any age who are overweight or obese and have 1 or more additional risk factors for diabetes	At least every 3 years
Alcohol misuse	All adults	At routine exams
Blood pressure	All adults	Every two years if your blood pressure reading is less than 120/80 mm Hg¹ Yearly if your systolic blood pressure reading is 120 to 139 mm Hg or your diastolic blood pressure reading is 80 to 89 mm Hg¹
Breast cancer	All women²	Yearly mammogram and clinical breast exam²
Cervical cancer	According to the American Cancer Society (ACS), women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.	Discuss with your healthcare provider³
Chlamydia	Women at increased risk for infection	At routine exams if at risk
Colorectal cancer	All women of average risk and in good health in this age group, through age 75. For women ages 76 to 85, talk with your healthcare provider about continued screening. For women 85 and older, experts don't advise screening.	The ACS recommends: Several tests are available and used at different times. For tests that find polyps and cancer: Flexible sigmoidoscopy every 5 years⁴, or Colonoscopy every 10 years, or CT colonography (virtual colonoscopy) every 5 years⁴ For tests that primarily find cancer: Yearly fecal occult blood test⁵, or Yearly fecal immunochemical test every year⁵, or Stool DNA test, every 3 years⁵ You will need a follow-up colonoscopy if you choose any test other than a colonoscopy and you have an abnormal result. Screening recommendations vary among expert groups. Talk with your doctor about which test is best for you. Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your health history and what colorectal cancer screening schedule is best for you.
Depression	All adults who have access to a clinical practice that has staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up	At routine exams
Gonorrhea	Sexually active women who are at increased risk for infection	At routine exams if at risk
HIV	Anyone at increased risk for infection	At routine exams if at risk
Hepatitis C	Anyone at increased risk; 1 time for those born between 1945 and 1965	At routine exams
High cholesterol and triglycerides	All women ages 20 and older at increased risk for coronary artery disease	At least every 5 years, or more frequently if recommended by your healthcare provider⁶
Lung cancer	Adults age 55 to 80 who have smoked	Yearly screening in smokers with 30 pack per year history of smoking or who quit within 15 years
Obesity	All adults	At routine exams
Osteoporosis, postmenopausal	All women ages 65 and older⁷	Bone density test at age 65, then follow-up as recommended by healthcare provider⁷
Syphilis	Anyone at increased risk for infection	At routine exams if at risk
Tuberculosis	Anyone at increased risk for infection	Check with your healthcare provider
Vision	All adults⁸	Every 1 to 2 years; if you have a chronic disease, check with your healthcare provider for exam frequency
Counseling	Who needs it	How often
Aspirin for prevention of cardiovascular problems	Women ages 55 to 79 when the potential benefits from reducing ischemic strokes outweigh the potential harm from an increase in gastrointestinal hemorrhage	Discuss with your healthcare provider
Diet and exercise	Adults who are overweight or obese	When diagnosed and at routine exams
Fall prevention (exercise, vitamin D supplements)	All women in this age group	At routine exams
Sexually transmitted diseases prevention	All women at increased risk	At routine exams
Tobacco use and tobacco-related disease	All adults	Every exam
Immunization	Who needs it	How often
Tetanus/diphtheria/ pertussis (Td/Tdap) booster	All adults	Td: Every 10 years Tdap is recommended if you are in contact with a child 12 months or younger. Either Td or Tdap can be used if you have no contact with infants.
Chickenpox (varicella)	All adults age 65 and older who have no previous infection or documented vaccinations*	Two doses; second dose should be given at least 4 weeks after the first dose
Flu (seasonal)	All adults	Yearly, when the vaccine becomes available in the community
Hepatitis A vaccine	People at risk⁹	Two doses given 6 months apart
Hepatitis B vaccine	People at risk¹⁰	Three doses; second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose)
Haemophilus influenzae Type B (HIB)	Women at increased risk for infection, talk with your healthcare provider	1 to 3 doses
Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)	All adults age 65 and older	1 dose of each vaccine
Zoster	All women ages 60 and older	One dose

¹Recommendation from the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure

²American Cancer Society

³The American Congress of Obstetricians and Gynecologists currently recommends that women ages 30 and older get a Pap test once every three years and that women with certain risk factors (or with increased risk) may need more frequent screening. It's reasonable to discontinue screening after three or more consecutive negative Pap tests and no abnormal results within the last 10 years once a woman turns 65 or 70.

⁴If the test is positive, a colonoscopy should be done

⁵The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

⁶Recommendation from ACOG

⁷Recommendation by the USPSTF

⁸Recommendation from the American Academy of Ophthalmology

⁹For complete list, see the CDC website

¹⁰For complete list, see the CDC website

*Exceptions may exist; discuss with your healthcare provider

Other guidelines from the USPSTF

Immunization schedule from the CDC

Updated:

July 25, 2018

Sources:

Standards of Medical Care in Diabetes, 2016, American Diabetes Association

Reviewed By:

Adler, Liora C, MD,Cunningham, Louise, RN,Freeborn, Donna, PhD, CNM, FNP