If You’re Over 65, You May Not Need These Common Medical Tests and Screenings

Fact checked by Nick Blackmer

Key Takeaways

• Older adults who seek healthcare are at risk for overtreatment and having screenings that they don’t need.

• Many common medical tests are not recommended after a certain age or if you’re not having symptoms.

• Patients should ask their healthcare provider to explain why a test is recommended and speak up if they aren’t sure why it’s needed.
  

After the age of 65, many people find themselves in a healthcare provider’s office more frequently for help with managing a chronic disease or just to “keep an eye on” their health. Since having access to quality healthcare in the United States is not a given, being proactive about your health if you’re able is generally a smart move.

That said, there can be such a thing as too much of a good thing—even when it comes to medical care. Many older adults don’t realize that some routine screenings and treatments may not be necessary and can even be harmful for them.

A recent study highlighted the need for safeguards to avoid overtreating older adult patients, which can include unnecessary tests and screenings, particularly for prostate cancer (PSA test), urinary tract infections (UTI), and diabetes.

The study concluded that decision support tool interventions like electronic alerts and warnings helped providers reduce incidents of unnecessary PSA testing by 9% and UTI screenings by 5.5%. They also made providers aware of when tests they’d ordered for a patient may not be needed.

“This shows that alerts like the ones used in this study can help curtail overuse of tests and treatments,” study lead author Stephen Persell, MD, MPH, professor of medicine at Northwestern University Feinberg School of Medicine, told Verywell. “We are always getting continuing education as clinicians. This type of nudge can help remind us of things we’ve learned previously when it is directly relevant to a patient we are working with.”

Related: USPSTF: Risks of Daily Aspirin for Older Adults Outweigh Benefits

What Are the Risks of Over Treating Older Adults?

Ordering a simple screening or adjusting a treatment plan may not sound like a big deal, but it can actually have negative health consequences down the road for older adults. It can also be expensive, time-consuming, and stressful.

Take a routine screening for a UTI. Many older women naturally have bacteria in their bladders that can cause a UTI test to come back positive. However, just having the bacteria in their urinary tract doesn’t mean it’s causing an active infection—especially if they don’t have any symptoms.

When a patient with no symptoms gets a positive screening, it may lead to an antibiotic prescription that’s not needed, but that could come with side effects like nausea, diarrhea, and dizziness. Big picture, prescribing antibiotics that patients don’t need contributes to antibiotic resistance—an already big and growing problem.

Prostate cancer screenings are another common example. One study found that PSA testing in men over the age of 69 often results in false positives, which leads to invasive procedures and side effects from treatment. That’s part of why the U.S. Preventive Services Task Force (USPSTF) recommends against PSA screenings for men aged 70 years and older.

Another risk for older adults is the health negative consequences of overtreating diabetes. While it is important to closely manage blood sugar levels, glycemic control needs to be modified as people get older and their bodies change.

Katherine Ward, MD, a board-certified geriatrician with Stanford Senior Care, told Verywell that diabetes management guidelines should be loosened for older adults because they have an increased risk of hypoglycemia (low blood sugar), which can be a life-threatening emergency.

“There is a lot of awareness that some tests and treatments in medicine are used in clinical situations where they haven’t been shown to be beneficial,” said Persell. “At best, it is likely that doing the tests hasn’t been shown to add value. At worst, they can potentially lead to downstream harms.”

Related: What Are Target Blood Sugar Levels for Older Adults?

Which Treatment and Screenings Should Be Modified for Older Adults—or Avoided?

Experts say there are other common medical tests that could be modified in older adults or even skipped for some patients. Providers have to weigh the benefits against the possible harms in each case. The decision to screen or not should be based on a patient’s health history, current physical health, and life expectancy.

Common medical tests and screenings that older adults might not need include:

• Colonoscopy

• Mammogram

• Pap smear

• Anxiety screenings

• Type 2 diabetes screenings

“There are thousands of tests out there,” said Ward. “But if the patient is not having any symptoms, it is probably not necessary. Screening or testing for older adults should only be done if a doctor thinks a disease might be present.”

Related: Older Adults Should Be Cautious ABout Taking These 6 OTC Drugs

Which Health Screenings Are Highly Recommended for Older Adults?

While there might be some tests and screenings that older adults don't need, that doesn’t mean they should forgo routine medical care. They should have annual well visits and physicals and ask their provider about getting routine screenings and vaccinations that are recommended for the older adult population:

• High blood pressure

• Cholesterol levels

• Vision and hearing exam

• Bone density scan (DEXA scan)

• Influenza vaccine

• COVID vaccine

• Pneumococcal vaccine

• RSV vaccine

Related: Should Older Adults Be Concerned About Colonoscopy Complications?

What Can Providers Do?

Students don’t get a lot of training in geriatric care in medical school, according to Ward. As a result, many primary care providers are not well-versed in treating older adults. That lack of knowledge could be contributing to the overtreatment of their older patients.

To help combat the problem, the researchers behind the latest study offered providers who took part in the study education and embedded alerts in the electronic medical record system. The warnings popped up if the provider ordered a treatment that wasn’t not recommended for the age group. The researchers found that these interventions resulted in a significant reduction of older adults getting care that didn’t have any added benefit for their health.

Another active initiative to help providers and patients discuss what tests are necessary and which ones may not be is the Choosing Wisely campaign. The campaign lists 45 examples of common tests or treatments that don’t have strong supporting evidence behind them.

“I think it’s important for clinicians to think several steps ahead when choosing tests,” said Persell. “We always need to ask ourselves—how will these results change what I do? Is it likely that pursuing the results of a positive test will benefit this patient? And does the medical evidence support what I’m doing?”

Providers aren’t the only ones who can ask questions, though. Patients should speak up if they don’t understand why a test is being ordered or a screening is being recommended. If your provider wants you to have a test or screening, ask them why. Find out what the benefits and risks are and why they think it’s important for your health.

What This Means For You

Older adults may be getting over-screened with common medical tests that don’t offer much benefit and may even be harmful. Asking your provider to explain why a test or screening is recommended creates an honest, open dialogue that can help you avoid getting medical treatments that you don’t need.

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Read the original article on Verywell Health.