Healthy aging: Clinical guidance and resources
Aging brings changes in health, function and life circumstances that shape evolving care plans.
As the U.S. population ages, family physicians increasingly care for older adults with diverse needs, from preventive care and functional assessment to chronic disease management and caregiver support. Clinical guidance on aging evolves rapidly as evidence grows around multimorbidity, cognitive decline, mobility and quality-of-life concerns.
This page brings together evidence-based resources that help you support aging adults with comprehensive, person-centered care. Find practical tools on geriatric assessments, medication management, fall prevention and chronic-condition care that empower you to promote independence, safety and well-being across the aging continuum.
Guidelines and recommendations
Clinical practice guidelines
Management of acute and recurrent gout
(Endorsed, April 2017)
The guideline, Management of Acute and Recurrent Gout, was developed by the American College of Physicians and was endorsed by the American Academy of Family Physicians (AAFP).
Key recommendations
Corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose colchicine should be prescribed for patients who have acute gout.
Long-term, urate-lowering therapy should not be initiated in most patients after their first gout attack or in patients who have infrequent gout attacks.
A discussion of the benefits, harms, costs and individual preferences should be held with patients who have recurrent gout attacks before initiating urate-lowering therapy and concomitant prophylaxis.
Testosterone treatment in adult men with age-related low testosterone
(Endorsed, May 2019)
The guideline, Testosterone Treatment in Adult Men with Age-Related Low Testosterone, was developed by the American College of Physicians and endorsed by the AAFP.
Key recommendations
For individuals with age-related low testosterone and sexual dysfunction who want to improve sexual function, the decision to initiate testosterone therapy should occur following a discussion of the potential benefits, harms, costs and patient's preferences.
For individuals with age-related low testosterone and sexual dysfunction who decide to initiate testosterone therapy, symptoms should be reevaluated within 12 months and treatment should be discontinued when there is no improvement in sexual function.
For individuals with age-related low testosterone and sexual dysfunction who decide to initiate testosterone therapy, intramuscular and transdermal formulations have similar clinical effectiveness and harms. However, intramuscular formulations are preferred as the costs are considerably lower.
Testosterone therapy is not recommended in men with age-related low testosterone to improve energy, vitality, physical function or cognition.
Benign paroxysmal positional vertigo
(Affirmation of value, November 2016)
The guideline, Benign Paroxysmal Positional Vertigo (BPPV), was updated by the American Academy of Otolaryngology—Head and Neck Surgery and categorized as Affirmation of Value by the AAFP.
Key recommendations
Posterior semicircular canal BPPV should be diagnosed when vertigo associated with nystagmus is provoked by the Dix-Hallpike maneuver.
If the patient has a history compatible with BPPV and the Dix-Hallpike test is negative, a supine roll test should be performed to assess for lateral semicircular canal BPPV.
BPPV should be differentiated from other causes of imbalance, dizziness and vertigo.
Patients with BPPV should be questioned for factors that modify management, including impaired mobility or balance, central nervous system (CNS) disorders, lack of home support and increased risk for falling.
Radiographic imaging and/or vestibular testing should not be used in patients diagnosed with BPPV, unless the diagnosis is uncertain or there are additional symptoms or signs unrelated to BPPV that warrant testing.
Patients with posterior canal BPPV should be treated with a canalith repositioning procedure (CRP). Post-procedural postural restrictions should not be recommended after repositioning procedure is performed.
BPPV should not be routinely treated with vestibular suppressant medications such as antihistamines or benzodiazepines.
Patients with persistent symptoms should be evaluated for unresolved BPPV or underlying peripheral vestibular or CNS disorders.
Patients should be educated regarding the impact of BPPV on their safety, the potential for recurrence and the importance of follow-up.
See the full recommendation for further details, including specifics about the Dix-Hallpike maneuver and a treatment algorithm.
Treatment of hypertension in adults over age 60
(Jointly developed, January 2017)
The guideline, Treatment of Hypertension in Adults Over Age 60 to Higher vs. Lower Targets, was developed by the American College of Physicians and the AAFP.
Key recommendations
Adults over age 60 with persistent systolic blood pressure ≥150 mm Hg should be treated to achieve a target systolic blood pressure of <150 mm Hg.
Adults 60 years or older with a history of stroke or transient ischemic attack (TIA) may be treated to a lower target blood pressure of <140 mm Hg to reduce the risk of recurrent stroke.
Adults over age 60 with a high cardiovascular risk may be treated to a lower target blood pressure of <140 mm Hg.
Treatment goals should be based on a periodic discussion of the benefits and harms of specific blood pressure targets.
These recommendations should be used to augment the those included in the AAFP's Blood Pressure Targets in Adults with Hypertension guideline.
Clinical preventive service recommendations
The U.S. Preventive Services Task Force (USPSTF) provides evidence-based recommendations on screening, counseling and preventive interventions for clinical care.
The USPSTF recommendation addresses community-dwelling adults 65 and older who are at increased risk for falls. Evidence shows that exercise interventions provide a moderate net benefit in preventing falls and fall-related morbidity in this population and clinicians should recommend them. Multifactorial interventions provide only a small net benefit, so clinicians should individualize their use based on the patient’s prior fall history, medical conditions and preferences. Exercise interventions receive a B recommendation and individualized use of multifactorial interventions receives a C recommendation.
The USPSTF recommendation on screening for primary open-angle glaucoma in adults applies to adults 40 and older seen in primary care who do not have signs or symptoms of glaucoma. After reviewing the available evidence, the Task Force found the benefits and harms of screening are uncertain and current evidence is insufficient to determine whether screening improves health outcomes. Because the evidence is insufficient to determine the balance of benefits and harms, the Task Force does not recommend for or against screening and notes that more research is needed.
The USPSTF recommendation on screening for hearing loss in older adults applies to asymptomatic adults 50 and older with age-related hearing loss. After reviewing the available evidence, the Task Force found the benefits and harms of screening are uncertain and current evidence is insufficient to determine whether screening improves health outcomes. Because the evidence is insufficient to determine the balance of benefits and harms, the Task Force does not recommend for or against screening and notes that more research is needed.
The USPSTF recommendation on screening for impaired visual acuity in older adults applies to asymptomatic adults 65 and older who present in primary care without known vision impairment and are not seeking care for vision problems. After reviewing the available evidence, the Task Force determined the benefits and harms of screening are unclear and current evidence is insufficient to show whether screening improves health outcomes. Because the evidence is insufficient to determine the balance of benefits and harms, the Task Force does not recommend for or against screening and indicates that additional research is needed.
The USPSTF recommendation on screening for abdominal aortic aneurysm (AAA) applies to asymptomatic adults 50 and older, with most evidence focused on men ages 65 to 75. The Task Force recommends one-time screening with ultrasonography for men ages 65 to 75 who have ever smoked, based on moderate net benefit (B recommendation). For men ages 65 to 75 who have never smoked, clinicians should selectively offer screening rather than screen routinely, given the small net benefit (C recommendation). The Task Force recommends against routine screening in women who have never smoked and have no family history of AAA because the harms outweigh the benefits (D recommendation). For women ages 65 to 75 who have ever smoked or have a family history of AAA, the evidence is insufficient to determine the balance of benefits and harms, so the Task Force does not recommend for or against screening and calls for more research.
The USPSTF recommendation on screening for cognitive impairment applies to community-dwelling older adults and addresses both dementia and mild cognitive impairment (MCI). After reviewing the available evidence, the Task Force found the benefits and harms of screening could not be determined, and current evidence is insufficient to show whether screening improves patient-centered outcomes. Because the evidence is insufficient to determine the balance of benefits and harms, the Task Force does not recommend for or against screening and notes that more research is needed.
The USPSTF recommendation on screening for intimate partner violence applies to women of reproductive age, including those who are pregnant and postpartum. The Task Force recommends screening in this population and referring those who screen positive to appropriate multicomponent services, based on a moderate net benefit (B recommendation). For screening for caregiver abuse and neglect in older or vulnerable adults without recognized signs or symptoms, the evidence is insufficient to determine the balance of benefits and harms. Because of this lack of evidence, the Task Force does not recommend for or against screening in this group and calls for additional research.
Related resources
Our Alzheimer’s and dementia care toolkit features comprehensive diagnosis and treatment resources for family physicians and caregivers.
Visit Alzheimer’s and dementia care toolkitFind additional tools and resources to support recognition, evaluation and ongoing care for patients with cognitive impairment.
Patient education
The AAFP patient education website, FamilyDoctor.org, provides many patient-facing resources.