Screening area or intervention	Recommendation	Comments
Abdominal aortic aneurysm	Recommends one-time screening by ultrasound for men 65 to 75 years of age (AAFP limits to men who have ever smoked)	Significant decrease in mortality for men 65 to 75 years of age, but increased mortality for those older than 75 years28
Alcohol misuse	Recommends screening and counseling (15-minute intervention with at least one follow-up) in primary care settings	Those older than 65 years were included in nine of the 12 studies reviewed for the recommendation; the intervention led to positive health outcomes up to four years later 32
Anemia (iron deficiency)	No recommendation for nonpregnant adults	Guideline from National Anemia Action Council advises to screen with complete blood count every year for persons with underlying chronic conditions, and every five years for those 50 years and older 33
Aspirin prophylaxis for primary CHD prevention	Recommends discussion with patients at increased risk of CHD (i.e., men older than 40 years, postmenopausal women, and younger women with increased risk)	Four out of five studies included patients up to 79 years of age; decrease in relative risk appears greatest in older participants (70 to 84 years of age); increased risk of intracranial and gastrointestinal bleeding must be considered—these bleeds appear to be less likely with decreasing aspirin dosage; relative risk for all-cause mortality is 0.9317
Back pain (low) —interventions to prevent onset	No interventions effective (specifically modification of risk factors, back schools, back belts, and physical exercise)	—
Bacteriuria (asymptomatic)	Recommends against screening men and nonpregnant womens	Infectious Diseases Society of America recommends against screening older adults who are institutionalized or living in the community, and persons with diabetes, catheters in place, or spinal cord injuries34
Bladder cancer	Recommends against screening	Greatest risk factor is smoking35
Breast cancer	Recommends screening mammography every one to two years starting at 40 years of age with or without clinical breast examination	Nearly two thirds of deaths from breast cancer occur in patients older than 65 years; USPSTF concludes that recommendation is generalizable to women 70 years and older
	Screening for breast cancer susceptibility genes only in those at higher risk	A meta-analysis of cost-effectiveness included multiple studies of women up to 79 years of age and showed that the cost per year of life saved was comparable to that of treating hypertension; however, the harms outweigh the benefits in women with the shortest life expectancy29
	No recommendation for or against teaching of self-breast examination, or for clinical breast examination alone
	AAFP recommends that women be counseled on benefits and risks of mammography before screening
Calcium supplements	Recommends that all females 11 years and older be counseled on maintaining good calcium intake to prevent osteoporosis	A three-year RCT of ambulatory persons older than 65 years showed that 700 IU of vitamin D plus 500 mg of calcium citrate malate daily reduced the odds of falling in ambulatory women by 46 percent; no effect was found on men36
Carotid artery stenosis	USPSTF recommends against screening asymptomatic persons	Ultrasound screening leads to carotid endarterectomies, which give rise to strokes; alternatively, screening with carotid angiography leads to strokes37
Cervical cancer	Recommends against routine screening in persons older than 65 years who have a recent history of normal Papanicolaou (Pap) smears and are not high risk; recommends against routine Pap smears in those whose uterus has been removed for noncancerous disease	—
CHD	Recommends against screening persons at low risk; no recommendation for or against screening high-risk patients with electrocardiography, exercise treadmill, or computed tomography	—
Cholesterol	Strongly recommends screening all men 35 years and older and all women 45 years and older who are at increased risk of CHD; include measurement of low- and high-density lipoproteins	Results of three major studies including older adults showed reduction of cardiovascular events and all-cause mortality similar to that in persons younger than 70 years; these trials were based on statin therapies18
		NCEP-ATP III update notes that aggressive statin therapy for those older than 70 years is supported in persons with established cardiovascular disease and in those at high risk18
Colorectal cancer	Strongly recommends screening for women and men 50 years and older	Colorectal cancer incidence is doubled every seven years from 50 years of age; decreased mortality from 50 to 80 years of age has been established in fecal occult blood testing and sigmoidoscopy; screening colonoscopy has been estimated in models to decrease mortality by 61 percent; consideration of life expectancy should be included in decision to screen30
Dementia (Alzheimer's disease)	Cannot recommend for or against screening	—
Dental	No recommendations for adults	—
Depression in adults	Recommends screening for adults	The risk of suicide is highest among white men older than 65 years38
Diabetes mellitus	Recommends screening in adults with hypertension or hyperlipidemia	The ADA recommends routine screening every three years in asymptomatic persons starting at 45 years of age, and in overweight persons younger than 45 years who have at least one risk factor (e.g., sedentary lifestyle, cardiovascular disease, black or Hispanic race)39
Diet	Recommends intensive counseling for adult patients with risk factors for cardiovascular disease and diet-related chronic disease	—
Drug abuse	Cannot recommend for or against routine screening; no current AAFP recommendation	Update in progress by USPSTF
Glaucoma	Cannot recommend for or against screening	—
Hearing impairment (older adults)	Recommends screening by questioning about patients' hearing	Update in progress by USPSTF
Hemochromatosis	Recommends against routine genetic screening	—
Hormone therapy	Recommends against routine use of estrogen and progesterone combinations in postmenopausal women, and against routine use of estrogen in women with a hysterectomy	—
Hypertension	Strongly recommends routine screening in persons 18 years and older	Update in progress by USPSTF
Lung cancer	Recommends against screening asymptomatic persons	—
Obesity in adults	Recommends screening all adults for obesity and offering intensive counseling and behavioral interventions; cannot recommend for or against low- or moderate-intensity counseling in obese adults or any counseling in overweight adults	Counseling at least twice per month for a minimum of three months is considered intensive counseling
Oral cancer	Cannot recommend for or against routine screening	—
Osteoporosis	Recommends routine screening in women 65 years and older and in women 60 to 64 years of age with increased risk factors	—
Ovarian cancer	Recommends against routine screening	—
Pancreatic cancer	Recommends against routine screening	—
Peripheral arterial disease	Recommends against routine screening	—
Physical activity	Cannot recommend for or against counseling on benefits of physical activity; AAFP recognizes that physical activity is desirable, but cannot recommend for or against	—
Prostate cancer	Cannot recommend for or against screening with prostate-specific antigen or digital rectal examination; any screening should be done after discussion with the patient	It is unlikely that any man with a life expectancy of less than 10 years will receive benefit from screening; the large number of false-positive results and unclear benefit of treatment leaves screening controversial31
Skin cancer	Cannot recommend for or against screening for, or counseling on, prevention	Most skin cancers are found in older adults; whites have 20 times the risk of blacks and four times the risk of Hispanics of developing skin cancer; by 50 years of age, men have a much higher incidence of and mortality from melanoma than women; these differences become larger with increasing age; by 65 years of age, mortality rates are 25 per 100,000 for men and five per 100,000 for women40
		Update in progress by USPSTF
Suicide risk	Cannot recommend for or against screening in the general population	Suicide risk increases with age in persons older than 65 years; risk factors include depression, alcoholism, chronic illness, divorced marital status, and male sex38
Testicular cancer	Recommends against routine screening in asymptomatic adolescents and adults	—
Thyroid cancer	Routine screening by neck palpation or ultrasonography is not recommended in asymptomatic persons	Update in progress by USPSTF
Thyroid disease	Cannot recommend for or against routine screening in asymptomatic adults	—
Tobacco counseling	Strongly recommends screening all adults for tobacco use; medications and brief intervention counseling (less than three minutes) are recommended	—
Vaccinations	CDC recommends tetanus toxoid and diphtheria toxoid vaccine for everyone every 10 years, influenza vaccine for everyone each year, and pneumococcal vaccine by 65 years of age	The USPSTF no longer evaluates, but defers to the CDC for all recommendations
Visual impairment (older adults)	Recommends screening for all adults 65 years and older	Update in progress by USPSTF
Vitamin supplements	USPSTF and AAFP cannot recommend for or against vitamins A, C, and E; multivitamins with folic acid; or antioxidants for the prevention of cancer or cardiovascular disease; AAFP recommends against beta-carotene for the prevention of cancer or cardiovascular disease	A three-year RCT of ambulatory men and women older than 65 years showed that 700 IU of vitamin D plus 500 mg of calcium citrate malate daily reduced the odds of falling by 46 percent in ambulatory women; no effect was found in men36