Health Maintenance: Ages 65 Years and Older

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Last modified 22/04/2025

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Chapter 6 Health Maintenance: Ages 65 Years and Older

IMPORTANT CONSIDERATIONS (PHYSIOLOGIC CHANGES)

The 65 years and older age group is notable for maturity, leisure, and age-related health changes. Health care is still directed toward prevention, but it becomes more and more occupied by the management of general medical and age-related illness. Although reproductive health issues no longer are the focus of well-women visits, the women’s health care provider is often still the patient’s primary entry point for health care.

Leading Causes of Death

• Cardiovascular disease
• Coronary artery disease
• Colorectal, lung, and breast cancer
• Cerebrovascular disease
• Obstructive lung disease
• Alzheimer’s disease
• Pneumonia/influenza
• Diabetes mellitus and its complications
• Renal disease
• Accidents

Leading Causes of Morbidity

• Nose, throat, and upper respiratory conditions
• Osteoporosis
• Arthritis
• Hypertension
• Urinary and fecal incontinence
• Heart disease
• Musculoskeletal and soft tissue injuries
• Hearing and vision impairment
• Colon disease (e.g., diverticulitis)

SCREENING

History

• Reason for visit
• Health status: medical, surgical, family
• Dietary/nutritional assessment
• Physical activity and activities of daily life
• Tobacco, alcohol, other drugs (concurrent medications including complementary and alternative medicines)
• Abuse/neglect (two thirds of the victims of elder abuse are women, with almost 90% of abuse cases occurring in the home)
• Sexual practices/activity
• Urinary and fecal incontinence (These issues become more common with childbearing and age, but patients seldom volunteer these complaints.)

Physical

• Height
• Weight (body mass index)
• Blood pressure
• Oral cavity
• Neck: adenopathy, thyroid
• Breasts
• Abdomen
• Pelvic and rectovaginal examination
• Skin
• Hearing and vision screening (including glaucoma testing)

Laboratory

Periodic

• Pap test (physician and patient discretion after three consecutive normal test results if low risk)
• Urinalysis/dipstick
• Cholesterol, high-density lipoprotein cholesterol (every 3 to 5 years)
• Fecal occult blood test (Testing requires the collection of two to three samples of stool collected by the patient at home to be valid. A single stool sample collected at the time of digital rectal examination is not sufficient to adequately screen for colon cancer.)
• Sigmoidoscopy (every 3 to 5 years; double-contrast barium enema study may be substituted or a complete colonoscopy may be performed every 10 years)
• Thyroid-stimulating hormone test (every 3 to 5 years)

As Indicated by Risk Factors

• Hemoglobin
• Fasting glucose test
• STD testing
• Human immunodeficiency virus testing
• Tuberculosis skin test
• Lipid profile

Imaging

• Mammography
• Bone density assessment (Bone mineral density testing should be recommended to all postmenopausal women age 65 years or older. In the absence of new risk factors, densitometry should not be performed more frequently than every 2 years.)

COUNSELING

As function changes as a result of aging, both the patient and the provider must be vigilant in detecting subtle losses of abilities and must be prepared to make accommodations as needed.

Sexuality

• Sexual functioning
• Sexual behaviors
• STDs

Fitness

• Hygiene (general and dental)
• Dietary/nutritional assessment (Women in this age group should take 1200 mg of calcium and 10 μg of vitamin D per day to prevent osteoporosis.)
• Exercise: discussion of program and the importance of remaining physically active

Psychosocial Evaluation

• Neglect/abuse
• Lifestyle/stress
• Depression/sleep disorders (These are particularly prevalent, but often overlooked, as patients age.)
• Family relationships
• Job/work/retirement satisfaction

Cardiovascular Risk Factors

• Hypertension
• Dyslipidemia
• Obesity
• Diabetes mellitus
• Sedentary lifestyle

Health/Risk Behaviors

• Hormone replacement therapy
• Breast cancer chemoprophylaxis (selective estrogen receptor modulator therapy for women at high risk)
• Injury prevention

• Safety belts and helmets
• Occupational hazards
• Recreational hazards
• Fall prevention
• Hearing and visual acuity/glaucoma screening
• Breast self-examination
• Skin exposure to ultraviolet rays
• Suicide: depressive symptoms
• Tobacco, alcohol, other drugs

COUNSELING RESOURCES

American College of Obstetricians and Gynecologists: A healthy diet. ACOG Patient Education Pamphlet BP151. Washington, DC, ACOG, 2001.
American College of Obstetricians and Gynecologists: Cholesterol and your health. ACOG Patient Education Pamphlet AP101. Washington, DC, ACOG, 2004.
American College of Obstetricians and Gynecologists: Herbal products for menopause. ACOG Patient Education Pamphlet AP158. Washington, DC, ACOG, 2003.
American College of Obstetricians and Gynecologists: Hormone therapy. ACOG Patient Education Pamphlet AP066. Washington, DC, ACOG, 2003.
American College of Obstetricians and Gynecologists: Osteoporosis. ACOG Patient Education Pamphlet AP048. Washington, DC, ACOG, 2003.
American College of Obstetricians and Gynecologists: Staying active. ACOG Patient Education Pamphlet BP153. Washington, DC, ACOG, 2001.

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American College of Obstetricians and Gynecologists: Staying healthy (for women ages 65 and older). ACOG Patient Education Pamphlet BP141. Washington, DC, ACOG, 2004.
American College of Obstetricians and Gynecologists: Taking medications. ACOG Patient Education Pamphlet BP152. Washington, DC, ACOG, 2001.

INTERVENTIONS: IMMUNIZATIONS

Periodic

• Tetanus–diphtheria booster (every 10 years)
• Influenza vaccine (annually)
• Pneumococcal vaccine (once)

High-Risk Groups

• Hepatitis B vaccine

REFERENCES

Level II

Bradley CS, Zimmerman MB, Qi Y, et al. Natural history of pelvic organ prolapse in postmenopausal women. Obstet Gynecol. 2007;109:848.

Centers for Disease Control and Prevention. Use of mammograms among women aged ≥40 years—United States, 2000–2005. MMWR Morb Mortal Wkly Rep. 2007;26:49. 56

Huang A, Grady D, Blackwell T, Bauer D. Hot flushes, bone mineral density, and fractures in older postmenopausal women. Obstet Gynecol. 2007;109:841.

Level III

American College of Obstetricians and Gynecologists. Guidelines for Women’s Health Care, 2nd ed. Washington, DC: ACOG, 2002.

American College of Obstetricians and Gynecologists. Primary and preventive care. Clinical Updates in Women’s Health Care. 2007;VI(2):1.

American College of Obstetricians and Gynecologists. Routine cancer screening. Committee Opinion No. 356. Washington, DC: ACOG, 2006.

Lentz GM. History, physical examination, and preventive health care. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:148.

Nowalk MP, Zimmerman RK, Cleary SM, Bruehlman RD. Missed opportunities to vaccinate older adults in primary care. J Am Board Fam Pract. 2005;18:20.

Stenchever MA. Gynogeriatrics: A challenge for the 21st century. Obstet Gynecol (Editorial). 1997;90:632.

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