The level of evidence grades (A-D) are provided for the most significant recommendations and are defined at the end of the "Major Recommendations" field.
Health Assessment Screening, History, and Counseling
Ages 50 to 64 years
One health maintenance exam (HME) every 1 to 3 years according to risk status [D]
Age 65+ years
One HME at least every 2 years
Each HME should include:
- Height, weight, and body mass index (BMI)
- Risk evaluation and counseling (nutrition, obesity, physical activity, dental health, tobacco use [A], immunizations, human immunodeficiency virus (HIV) prevention [B], sexually transmitted infections prevention [B] and sexual health, sexual abuse, polypharmacy including over-the-counter and herbal preparations when appropriate, sun exposure)
- Safety (domestic violence, seat belts, helmets, firearms, smoke and carbon monoxide detectors)
- Behavioral assessment (depression, suicide threats, alcohol/drug use, anxiety, stress reduction, coping skills)
Blood Pressure Monitoring [A]
Ages 50 to 65+ Years
At every office visit and, at minimum, every 2 years. If blood pressure (BP) 120-139/80-89 or higher and/or presence of risk factors, more frequent monitoring is recommended.
Cholesterol and Lipid Screening [B]
Ages 50 to 65+ Years
Measure a complete fasting lipoprotein profile (i.e., total cholesterol, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglycerides) every 5 years if initial test is normal in low-risk adults. If multiple risk factors are present, more frequent measurements are recommended.
Diabetes Mellitus Screening
Ages 50 to 65+ Years
Fasting plasma glucose (FPG) every 3 years beginning at age 45. FPG may be performed earlier in patients at increased risk of diabetes (e.g., those with BMI > 25, family history and high-risk ethnic groups - African Americans, Native Americans, Hispanics, and Pacific Islanders)
Colorectal Cancer Screening [B] for Average Risk Adults
Ages 50 to 65+ Years
Fecal occult blood test (FOBT) annually and/or sigmoidoscopy every 5 years; or double contrast barium enema every 5 years; or colonoscopy every 10 years
Glaucoma Screening [C]
Ages 50 to 64 Years
No requirement unless high risk (e.g., increased intraocular pressure, family history, African Americans, people who have diabetes, myopia, regular/long-term steroid use, previous eye injury)
Age 65+ Years
Every 2 years; screen annually if high risk
Osteoporosis Screening [C]
Ages 50 to 64 Years
- Men or women on chronic glucocorticosteroids (prednisone > 7.5 mg/day, or equivalent, for > 6 months) and those who have received a solid organ transplant > 2 years ago should be screened.
- Post-menopausal women with any of the following: personal history of fracture without substantial trauma > age 40; family history of fracture (hip, wrist or spine in first-degree relative > age 50); current smoking; weight in lowest quartile (< 127 lbs); and frailty.
- Bone Mineral Density (BMD) test once for initial diagnosis. Do not repeat test more frequently than every 2 years (per Michigan Quality Improvement Consortium [MQIC Osteoporosis guideline]).
Age 65+ Years
Women age >65 regardless of risk factors
Cervical Cancer Screening [A] Pap Smear
Ages 50 to 64 Years
At least every 3 years, unless high risk (i.e., history of abnormal Pap results, sexually transmitted diseases, or HIV; sexual activity before age 18 or multiple partners; vaginal spotting or bleeding between periods, after intercourse, or after menopause; tobacco use) (Consider discontinuation for patients with surgical removal of cervix for benign conditions).
Age 65+ Years
May discontinue after age 65, based on clinical judgment according to risk status
Mammography [A] and Clinical Breast Exam [C]
Ages 50 to 70 years
Every 1 to 2 years
Age 70+ years
Shared decision-making after age 70
Prostate Cancer Screening [D]
Ages 50 to 65+ years
Age 50 to 65 years, shared decision-making for digital rectal examination (DRE) and/or prostate specific antigen (PSA) testing
Immunizations
Tetanus Diphtheria Acellular Pertussis/Tetanus-diphtheria (TdaP/Td) [A]
Ages 50 to 64 Years
TDaP once after age 11, then Td every 10 years
Age 65+ Years
Td every 10 years
Varicella [C]; Zoster [C]
Ages 50 to 65+ Years
Varicella as indicated by the Advisory Committee on Immunization Practices (ACIP) guidelines. Single dose zoster vaccine at age > 60 years
Influenza [B]
Ages 50 to 65+ Years
Annually
Pneumococcal Vaccine [B]
Ages 50 to 64 Years
No requirement, unless high risk
Age 65+ Years
Once at age 65; booster may be needed after 5 years
Definitions:
Levels of Evidence for the Most Significant Recommendation
- Randomized controlled trials
- Controlled trials, no randomization
- Observational studies
- Opinion of expert panel
