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Prevention Guidelines for Women 65+

Here are the screening tests and immunizations that most women at age 65 and older need. Although you and your health care provider may decide that a different schedule is best for you, this plan can guide your discussion.

Screening	Who needs it	How often
Alcohol misuse	All adults	At routine exams
Blood pressure	All adults	Every two years if your blood pressure reading is less than 120/80 mm Hg¹ Yearly if your systolic blood pressure reading is 120 to 139 mm Hg or your diastolic blood pressure reading is 80 to 89 mm Hg¹
Breast cancer	All women²	Yearly mammogram and clinical breast exam²
Cervical cancer	According to the American Cancer Society (ACS), women older than 65 who have had regular screening with normal results should not be screened for cervical cancer. Once screening is stopped, it should not be started again.	Discuss with your health care provider³
Chlamydia	Women at increased risk for infection	At routine exams if at risk
Colorectal cancer	All adults ages 50 and older	The ACS recommends: For tests that find polyps and cancer: Flexible sigmoidoscopy every 5 years⁴, or Colonoscopy every 10 years, or Double-contrast barium enema every 5 years⁴, or CT colonography (virtual colonoscopy) every 5 years⁴ For tests that primarily find cancer: Yearly fecal occult blood test⁵, or Yearly fecal immunochemical test every year⁵, or Stool DNA test, interval uncertain⁵ The tests that are designed to find both early cancer and polyps are preferred if these tests are available to you and you are willing to have one of these more invasive tests. Talk with your doctor about which test is best for you. Some people should be screened using a different schedule because of their personal history or family history. Talk with your doctor about your history and what colorectal cancer screening schedule is best for you.
Depression	All adults who have access to a clinical practice that has staff and systems in place to assure accurate diagnosis, effective treatment, and follow-up	At routine exams
Diabetes mellitus, type 2	Adults who are asymptomatic and have sustained blood pressure (treated or untreated) greater than 135/80 mm Hg	At least every 3 years
Gonorrhea	Sexually active women who are at increased risk for infection	At routine exams if at risk
HIV	Anyone at increased risk for infection	At routine exams if at risk
Lipid disorders	All women ages 20 and older at increased risk for coronary artery disease	At least every 5 years, or more frequently if recommended by your health care provider⁶
Obesity	All adults	At routine exams
Osteoporosis, postmenopausal	All women ages 65 and older⁷	Bone density test at age 65, then follow-up as recommended by health care provider⁷
Syphilis	Anyone at increased risk for infection	At routine exams if at risk
Tuberculosis	Anyone at increased risk for infection	Check with your health care provider
Vision	All adults⁸	Every 1 to 2 years; if you have a chronic disease, check with your health care provider for exam frequency
Counseling	Who needs it	How often
Aspirin for prevention of cardiovascular problems	Women ages 55 to 79 when the potential benefits from reducing ischemic strokes outweigh the potential harm from an increase in gastrointestinal hemorrhage	Discuss with your health care provider
Diet, behavioral counseling	Adults with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease	When diagnosed
Tobacco use and tobacco-related disease	All adults	Every visit
Immunization	Who needs it	How often
Tetanus/diphtheria/pertussis (Td/Tdap) booster	All adults	Td: Every 10 years Tdap is recommended if you are in contact with a child 12 months or younger. Either Td or Tdap can be used if you have no contact with infants.
Measles, mumps, rubella (MMR)	All adults age 65 and older who have no previous infection or documented vaccinations*	One dose
Chickenpox (varicella)	All adults age 65 and older who have no previous infection or documented vaccinations*	Two doses; second dose should be given at least 4 weeks after the first dose
Flu (seasonal)	All adults	Yearly, when the vaccine becomes available in the community
Hepatitis A vaccine	People at risk⁹	Two doses given 6 months apart
Hepatitis B vaccine	People at risk¹⁰	Three doses; second dose should be given 1 month after the first dose; the third dose should be given at least 2 months after the second dose (and at least 4 months after the first dose)
Pneumococcal (polysaccharide)	All adults	One dose
Zoster	All women ages 60 and older	One dose

¹Recommendation from the Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure

²Recommendation from the ACS. Currently, the U.S. Preventive Services Task Force (USPSTF) recommends screening every 2 years for women ages 50 to 74. The ACS recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them. The ACS also recommends annual clinical breast exams (CBEs) for women ages 40 and older. The USPSTF, however, believes there is not enough evidence to assess the value of CBEs for women ages 40 and older. Women should talk with their doctors about their personal risk factors and make a decision about whether they should have a CBE.

³The American Congress of Obstetricians and Gynecologists currently recommends that women ages 30 and older get a Pap test once every three years and that women with certain risk factors (or with increased risk) may need more frequent screening. It's reasonable to discontinue screening after three or more consecutive negative Pap tests and no abnormal results within the last 10 years once a woman turns 65 or 70.

⁴If the test is positive, a colonoscopy should be done

⁵The multiple stool take-home test should be used. One test done by the doctor in the office is not adequate for testing. A colonoscopy should be done if the test is positive.

⁶Recommendation from ACOG

⁷Recommendation by the USPSTF

⁸Recommendation from the American Academy of Ophthalmology

⁹For complete list, see the CDC website

¹⁰For complete list, see the CDC website

*Exceptions may exist; discuss with your health care provider

Other guidelines from the USPSTF

Immunization schedule from the CDC