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Preventive Screening for Seniors: Is That Test Really Necessary?

Caregivers and seniors often find themselves inundated with messages touting the benefits of this cancer detection test, or that diagnostic exam.

And, for those over 65, Medicare offers about a dozen free screenings—from bone density measurements to mammograms.

But, are all those tests really necessary?

The honest answer to this vital question is, regrettably, very complex.

Age is really just a number

Many health organizations, including, the American Cancer Society (ACS), and the Centers for Disease Control (CDC), use age-based cut-offs to determine recommendations for certain screenings.

While age is an easy metric to measure, too much reliance on these often arbitrary numbers can lead to confusing interactions between seniors and their doctors. “Screening tests are often done in elderly patients as a knee-jerk reaction,” says Damon Raskin, M.D., a board-certified internist and medical director for two skilled nursing facilities.

However, especially for an aging individual, there are several, more significant, factors to consider than the number of candles on their birthday cake. “What is more important than age is what’s going on with the patient,” Raskin argues.

For example, at age 50, it is recommended that all adults undergo a colonoscopy at least once every ten years.

However, a new study, conducted by researchers from the University of Texas, concluded that 23.4 percent of colonoscopies done on people aged 70 and older weren’t necessary, given the person’s age and estimated risk for colon cancer. While generally a safe test, a colonoscopy can result in internal bleeding, infection and puncturing of the intestines.

When considering whether or not to do a screening test on an elder, the first thing that should be considered is their overall health.

“You can have an 80-year-old who’s really like a 60-year-old in terms of their health. In these instances, screening tests such as mammograms and colonoscopies, can be extremely valuable,” says Raskin. “However, I’ve also seen 65-year-olds who have end-stage Parkinson’s or Alzheimer’s disease. For these individuals, I probably wouldn’t recommend screenings, for quality of life reasons.”

Routine screenings become just another part of the routine

Even if a physician recommends a screening to a senior, they still can’t force their patients to follow through.

Given this fact, why do so many seniors choose to undergo tests they may not need?

“I think one big problem is that people don’t always look at the consequences of tests,” Raskin laments.

For example, a suspicious-looking mammogram typically leads to a doctor recommendation for a breast biopsy (where a sample of breast tissue is removed and examined under a microscope). A minor form of surgery, breast biopsies still carry a risk of infection, particularly for older people whose immune systems are compromised. And, the vast majority—80 percent—of breast biopsies come back negative for cancer, according to the U.S. Department of Health and Human Services (HHS), meaning that many women are needlessly accepting infection risk.

Another reason, according to a recent Indiana University study, is because many seniors consider routine screenings as just that—part of a routine.