Below are five commonly discussed tests that geriatricians often recommend reviewing with older adults. The decision to continue or stop these tests depends on overall health, life expectancy, personal preferences, and individual risk factors.
1. PSA Test for Prostate Cancer (Men)
The PSA (prostate-specific antigen) blood test looks for signs of prostate cancer.
Why it may not always be helpful after 65
- PSA levels naturally rise with age.
- Elevated PSA does not always mean cancer.
- Many prostate cancers grow so slowly that they never cause symptoms during a person’s lifetime.
- Abnormal results often lead to biopsies, which carry risks such as infection, bleeding, and discomfort.
Who might still benefit?
- Men with a strong family history of prostate cancer.
- Men in excellent health who have a life expectancy of 10 years or more.
- Men experiencing urinary symptoms that need evaluation.
Potential harms
- False-positive results.
- Unnecessary biopsies.
- Treatment complications such as urinary incontinence or erectile dysfunction.
2. Colonoscopy for Colon Cancer
Colonoscopy is highly effective for detecting colorectal cancer, but it is not always necessary to continue into advanced age.
Current guidance
Many health organizations recommend:
- Routine screening through age 75 for average-risk adults.
- Ages 76–85: decisions should be individualized.
- After 85: routine screening is generally not recommended for most people.
Why?
The procedure carries increased risks with age:
- Bleeding.
- Colon perforation.
- Complications from sedation.
- Longer recovery.
If previous colonoscopies have been normal and no symptoms are present, repeating the test may offer limited benefit.
3. Bone Density (DEXA) Scans
DEXA scans measure bone strength and help diagnose osteoporosis.
Why they may be overused
If:
- Previous scans were normal,
- Bone health is stable,
- No new fracture risk factors have developed,
repeating the scan every year or two often provides little additional information.
Who should continue testing?
People with:
- Osteoporosis.
- Previous fractures.
- Long-term steroid use.
- Significant changes in health or medications.
Most experts recommend repeating DEXA scans only every few years unless risk factors change.
4. Mammograms (Women)
Mammograms remain valuable for many women, but the benefits decrease as age and other medical conditions increase.
Things to consider
A mammogram can detect cancers that:
- Grow very slowly.
- Might never become life-threatening.
- May lead to surgery or treatment that provides little benefit in someone with limited life expectancy.
When to continue
Women who:
- Are in good overall health.
- Have a life expectancy of at least 10 years.
- Wish to continue screening after discussing benefits and risks with their clinician.
5. Routine Full-Body Blood Test Panels
Many people request annual “complete blood work,” but extensive testing without symptoms is not always beneficial.
Examples include:
- Vitamin panels.
- Hormone testing.
- Tumor marker tests.
- Multiple inflammatory markers.
Why unnecessary testing can be harmful
- Incidental abnormal results are common.
- False alarms may lead to additional scans and procedures.
- Increased healthcare costs.
- Anxiety from findings that are ultimately harmless.
Doctors generally recommend ordering blood tests based on symptoms, medical history, medications, and known health conditions rather than testing everything routinely.
Tests That Usually Remain Important After 65
Some preventive services continue to provide strong benefits for many older adults:
- Blood pressure measurement.
- Diabetes screening (for those at risk).
- Cholesterol testing (when it will influence treatment decisions).
- Vision examinations.
- Hearing evaluations.
- Vaccinations (influenza, COVID-19, pneumococcal, shingles, RSV where appropriate).
- Osteoporosis assessment for those at increased fracture risk.
- Depression screening.
- Fall-risk assessment.
- Medication review to identify unnecessary or interacting drugs.
Why Geriatricians Individualize Care
Rather than relying on age alone, geriatric specialists often consider:
- Overall health and functional status.
- Number and severity of chronic illnesses.
- Mobility and independence.
- Estimated life expectancy.
- Personal values and goals.
- Potential risks versus benefits of testing.
For example, a healthy 68-year-old who exercises regularly may benefit from continued cancer screening, while a frail 88-year-old with several serious medical conditions may be more likely to experience harm than benefit from the same tests.
Key takeaway
Routine checkups after age 65 are still important, but they should focus on tests and treatments that are likely to improve health and quality of life. Screening decisions should be personalized rather than based solely on age. Discussing the benefits, risks, and your individual health goals with your healthcare provider is the best way to determine which tests remain appropriate for you.