To begin, I believe everyone should have a primary caregiver, preferably a physician, but a nurse practitioner may also be an excellent choice. Referrals to specialists should always be at his or her direction, or at least, with their knowledge. The primary caregiver will initially assess your cognition, fall risk, mood, cholesterol, and blood pressure. Based on your health status, they may also give you a number of blood tests as noted below.
• Blood pressure. Get it checked annually, or more often if yours is elevated. High pressure usually causes no symptoms until it is too late, and it is easily treated for a long period of time, and this can prevent late, serious, complications.
• Vitamin D. Blood levels of this vitamin should be checked if one has bone disorders–osteopenia (bone loss) or osteoporosis (bone softening). Low blood levels are linked to higher fracture risk. This test is controversial, and will be discussed later in detail.
• Vitamin B12. About 20 percent of adults over 60 are B12-deficient. Low B12 is more likely in some individuals, such as vegetarians.
• Liver and kidney. If one is on any medications, we like to check liver and kidney function yearly, as disclosed by blood testing.
• Thyroid hormones. This should be checked if one has thyroid disease symptoms, like memory loss, weight gain, constipation, sleepiness, or dry skin.
Note: Past or current smokers may need a yearly lung cancer scan. Get your ears and eyes checked as advised. Men 65 to 75 should have one ultrasound for abdominal aneurysm.
Blood Testing Basics
• Metabolic panel. A group of screening blood tests, aimed at detecting various problems such as anemia and dysfunction of the kidneys and liver
• Cholesterol. If you take a statin drug, get you. cholesterol checked annually. The National Institutes of Health advises this for everyone over 65. But if your total cholesterol is under 200 mg/dL, you may not need it. After 65, levels don’t change much unless you’ve had a big change in diet or weight.
• Blood glucose. Non-diabetic overweight adults should have their blood glucose (sugar) tested every three years until age 70. The American Diabetes Association says the same but has no upper age limit. If you are in your 70s and still being tested, ask your doctor whether you really need it.
ANNUAL PHYSICAL EXAMINATIONS
- A pooled analysis of seven observational studies conducted over the past 20 years assessed whether annual physical examinations (APE) are associated with all-cause mortality rates. One study was associated with a 45% lower hazard of all-cause mortality across all adult participants. This was in direct opposition to several other pooled analyses that did not show a reduction in the risk of all-cause mortality with APE.
- Many of us want to believe that APE, which is one of the core elements of primary care, has the potential to reduce mortality rates. Although this debate is not over, these overall data suggest that we are not doing good by recommending APE to our patients. My preference, however, is, after an initial complete physical exam, to engage in yearly consultations with one’s primary caregiver in order to review overall health status and to check specific items such as status of blood pressure and screening tests as noted above. A complete physical examination may be unnecessary unless otherwise indicated.
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