Preventive Care Checklist
Long, long ago, Benjamin Franklin noted that “an ounce of prevention is worth a pound of cure.” Even intoday’s environment of high tech medical procedures and sophisticated pharmaceuticals, Franklin’s observation holds true. There’s nothing better we can do for ourselves, at any age, than to strive for wellness by paying attention to our health before we get sick.
The preventive care measures I typically recommend to my patients fall into three categories:
- Lifestyle and habits
- Routine examinations
Your lifestyle and habits have a profound effect on your overall health and well-being, both today and down the road. All the things your mother taught you back in the day become even more relevant as you age.
- Eat a balanced diet rich in lean protein (like chicken and fish), fruits, vegetables, whole grains and dairy products. Avoid packaged, processed and fast foods.
- Exercise within your physical ability, doing something you find enjoyable. And get outside for a little fresh air and sunshine whenever you can.
- Don’t smoke.
- Moderate your alcohol consumption.
- Manage your stress level, perhaps turning to practices like relaxation techniques, meditation, or tai chi.
- Try to always get a good night’s sleep and maintain a regular sleep schedule.
- Stay engaged socially and spiritually. Get out and volunteer, play cards or golf, take a class, babysit the grandkids, see some old friends. And whatever your spiritual practice may be, stay in touch with it.
- And here’s one of the most important ones, from my perspective: develop a relationship with a primary care provider who you trust and who will be your long-term advisor. It doesn’t matter if it is a doctor, physician assistant or nurse practitioner, so long as you have someone who knows you and your conditions; someone with whom you feel comfortable talking about anything.
Once you’ve mastered the art of good, clean living, there are many things your physician can help you discover, keep an eye on, maintain, or heal as appropriate. Some discussion about the tests I routinely recommend follows.
- Blood work. Your blood can tell us so many important things about what’s going on in your body. Your physician will order blood tests specific to the conditions that may be ailing you; but the things I like to look at as a matter of course include:
- Lipid panel, or complete cholesterol test. This will show the amount of cholesterol and triglycerides in your blood—potential indicators of heart disease risk. Based on the results of this test, in combination with your family history and other factors (smoking, blood pressure), you and your physician can explore whether medical therapy is appropriate for you. Repeat tests over time will monitor your progress. I recommend this screening annually for all patients, regardless of age.
- GFR (glomerular filtration rate) test. This test looks at your renal function and indicates how well your kidneys are working.
- PSA (prostate-specific antigen) test. The purpose of this test is to detect prostate cancer. With my male patients over 70 years, I discuss avoiding the PSA test as the results become less reliable and the aggressiveness of the cancer tends to diminish; the potential complications of any procedure at that point may outweigh the benefits. I personally believe that a digital prostate examination is important whether or not the patient has the blood test and can be a reliable indicator of problems.
- Vitamin D level. Vitamin D deficiency is common and has been linked to cardiovascular disease and cancer. I typically order a Vitamin D level on patients, usually women, who have bone loss or other specific indications. More about this below.
- Blood pressure. This one isn’t news—we’re all used to donning the blood pressure cuff when we visit our doctors. But what you might not know is this: current research indicates that older adults might have previously been over-treated for high blood pressure. In fact, once you reach the age of 80+, a systolic (the first number of your blood pressure level) of 140 might be healthier than 120 for a number of reasons. I tend to take my older patients off blood pressure medications more often than I prescribe them.
- Colonoscopy. Beginning about age 50, depending on your family history and other risk factors, you should probably have a colonoscopy to screen for colon cancer every 3, 5, or 10 years. Once you reach your early 80s, however, routine colonoscopies are no longer recommended for most people as the risks increase. Your doctor should be happy to weigh the pros and cons and discuss your personal circumstances with you.
- Mammography. Unfortunately, the risk of breast cancer does not diminish with age. So I encourage my female patients over age 65 to have a mammography every other year. There has been some controversy of late about radiation exposure, but I continue to feel the benefit of this important test outweighs the potential risk for most patients. Please discuss your concerns and your unique situation with your own physician.
- Pap smears. I usually recommend pap smears (which screen for cervical cancer) for my female patients about every other year until the age of 70. After that time, unless the patient has some history of bleeding or other relevant problems, there is really no compelling reason to continue these tests.
- Bone density screening. The term “osteopenia” refers to bone loss and “osteoporosis” is a disease that weakens the bones. Both are, unfortunately, common as we age and affect significantly more women than men. A DEXA (duel x-ray absorptiometry) scan is a test that measures bone density in terms of a “T Score.” I recommend that my female (and some male) patients get a baseline DEXA scan at age 65. Based on the results, we’ll decide how often to repeat the test. When a patient has been diagnosed with this condition, I will also check their Vitamin D levels (which are likely to be low). I generally encourage Vitamin D therapy for everyone (regardless of gender, age, or bone density). For most people, that means 1,000 – 2,000 IUs per day of Vitamin D3.
- EKG and chest x-rays. I don’t order these tests routinely; only when a patient has a specific history or indication.
- Urinalysis. Urine tests are not needed for everyone; I’ll do this test when there is some indication of kidney problem or infection.
- Memory screening. We’ve all done the one where we arrive in the kitchen, having completely forgotten why we’re there. While it is true that some cognitive decline may naturally occur as we age, it is not a given. And forgetting where you’ve left the car keys does not necessarily indicate Alzheimer’s disease. If you have concerns about your memory or other cognitive function, your physician can help you figure out what’s going on. By all means, please don’t take tests over the Internet in an attempt to diagnose yourself! And remember, what’s good for your heart is also good for your brain. The things I outlined in the first section of this article can help you maintain your best brain function, as well.
- Medication review. At least once a year, your physician should take a look at every single medication (prescribed, over-the-counter, homeopathic, herbal, and supplements) that you are taking. Throw them all into a bag and bring them along to your visit. This is especially important if you have medicines prescribed by multiple doctors or things you’ve chosen for yourself. Your physician can scan for meds that can be removed from your routine and possible interactions between drugs. You might just end up feeling better and saving money as a result.
- Dental and vision exams. I routinely, albeit briefly, examine my patients’ eyes and mouth. Then I ask how long it’s been since they’ve visited the eye doctor and dentist. Don’t neglect these important aspects of a good wellness routine.
Immunizations continue to be pivotal in maintaining good health throughout the life cycle. Important vaccinations for older adults include:
- The Pneumovax, to prevent pneumonia, is generally recommended at age 65 with one booster seven years later (although this can vary depending on the overall health of the patient).
- Zostavax is an inoculation heavily encouraged for the 99% of the population who have been exposed to the varicella, or chicken pox, virus, which can erupt as a painful condition called shingles later in life. Start getting this shot annually also beginning at about age 60.
- The influenza vaccine, or flu shot, is increasingly available at your local pharmacy and other convenient locations. However, I would encourage you to have this administered by your physician if possible as there are different potencies available now. One is intended for those who are frailer, have an underlying illness, or whose immune systems are compromised; the other is not as strong and is more appropriate for healthier people. Be sure you are getting the right formula for your body.
- If you are planning to travel internationally, certain vaccinations may be required or recommended. Check with your travel agent or visit the Centers for Disease Control website for more specific information about the country(ies) you’ll be visiting.
Clearly, ongoing health is a function of taking responsibility for your own wellness. In the long run, any initiative you take today will serve you well.