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 healthcare provider may decide that a different schedule is best for you, this plan can guide your discussion. In addition, major organizations may vary in recommendations on these prevention guidelines.

Screening	Who needs it	How often
Type 2 diabetes or prediabetes	All adults starting at age 45 and adults without symptoms at any age who are overweight or obese and have 1 or more additional risk factors for diabetes	At least every 3 years
Alcohol use or misuse	All adults	At routine exams
Blood pressure	All adults	Every year if your blood pressure reading is less than 120/80 mm Hg If your blood pressure reading is higher than normal, follow the advice of your healthcare provider
Breast cancer	All women	Mammogram every other year or you may choose to continue mammograms every year
Cervical cancer	According to the American Cancer Society (ACS), women older than 65 who have had regular screening with normal results do not need to be screened for cervical cancer. Once screening is stopped, it should not be started again.	Discuss with your healthcare provider
Chlamydia	Women at increased risk for infection	At routine exams if at risk
Colorectal cancer	All women of average risk and in good health in this age group, through age 75. For women ages 76 to 85, talk with your healthcare provider about continued screening. For women 85 and older, experts don't advise screening.	The ACS recommends: Several tests are available and used at different times. For tests that find polyps and cancer: Colonoscopy every 10 years (recommended), or Flexible sigmoidoscopy every 5 years, or CT colonography (virtual colonoscopy) every 5 years For tests that primarily find cancer: Yearly fecal occult blood test or Yearly fecal immunochemical test every year, or Stool fecal immunochemical test plus DNA test, every 3 years You will need a follow-up colonoscopy if you choose any test other than a colonoscopy and you have an abnormal result. Screening recommendations vary among expert groups. Talk with your doctor about which test is best for you. Some people should be screened using a different schedule because of their personal or family history. Talk with your doctor about your health 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
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
Hepatitis C	Anyone at increased risk; 1 time for those born between 1945 and 1965	At routine exams
High cholesterol and triglycerides	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 healthcare provider
Lung cancer	Adults age 55 to 74 who in fairly good health and are at higher risk for lung cancer defined as current smokers or persons who have quit within past 15 years, and have a 30-pack-year smoking history (Eligibility criteria may vary across major organizations; Age limit may extend to age 80.) Talk with your healthcare provider for more information.	Yearly lung cancer screening with a low-dose CT scan (LDCT)
Obesity	All adults	At routine exams
Osteoporosis, postmenopausal	All women ages 65 and older	Bone density test at age 65, then follow-up as recommended by healthcare provider
Syphilis	Anyone at increased risk for infection	At routine exams if at risk
Tuberculosis	Anyone at increased risk for infection	Check with your healthcare provider
Vision	All adults	Every 1 to 2 years; if you have a chronic disease, check with your healthcare 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 healthcare provider
Diet and exercise	Adults who are overweight or obese	When diagnosed and at routine exams
Fall prevention (exercise, vitamin D supplements)	All women in this age group	At routine exams
Sexually transmitted diseases prevention	All women at increased risk	At routine exams
Tobacco use and tobacco-related disease	All adults	Every exam

Vaccines	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.
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 risk	Two doses given 6 months apart
Hepatitis B vaccine	People at risk	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)
Haemophilus influenzae Type B (HIB)	Women at increased risk for infection, talk with your healthcare provider	1 to 3 doses
Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)	All adults age 65 and older	1 dose of each vaccine
Recombinant zoster vaccine (RZV)	All women ages 50 and older	2 doses; the 2nd dose is given 2 to 6 months after the first. This is given even if you've had shingles before or had a previous zoster live vaccine.