Seniors' preventive health guidelines
Enjoy life with a healthy dose of independence and attitude. Take positive steps to ensure your continued well-being.
For men and women age 50 and older
Immunizations |
|
| COVID-19 | Recommended for everyone ages 6 months and older29 |
| Flu, annual | Recommended2 |
| Hepatitis A | For individuals with risk factors; for individuals seeking protection3 |
| Hepatitis B | Recommended 2, 3, or 4 dose series depending on vaccine or condition for ages 19 to 59.4 For individuals with risk factors; for individuals seeking protection.4 |
| Meningococcal | For individuals with risk factors present8 |
| MMR (measles, mumps, rubella) | Once, without proof of immunity or if no previous second dose5 |
| Pneumococcal (pneumonia) | Recommended for individuals 65 and older; and individuals under age 65 with risk factors7 |
| Td booster (tetanus, diphtheria) | Recommended once every 10 years15 |
| Varicella (chicken pox) | Recommended for adults without evidence of immunity; 2-dose series 4–8 weeks apart10 |
| Zoster (shingles) | Two-dose series of RZV 2-6 months apart |
Screenings/counseling/services |
|
| AAA (abdominal aortic aneurysm) | For ages 65-75 who have ever smoked, one-time screening for AAA by ultrasonography19 |
| Alcohol misuse | Screening for unhealthy alcohol use and behavioral counseling as needed for individuals 12 years and older |
| Blood pressure, height, weight, BMI, vision, and hearing | At annual exam. This includes coordination of preventive services. |
| BRCA risk assessment and genetic counseling/testing | Women with a positive result on the risk assessment tool or have a family history of breast, ovarian, tubal, or peritoneal cancer are recommended to receive genetic counseling and/or genetic testing.20 |
| Breast cancer | Recommended biennial screening mammography for women aged 40 years and older |
| Breast cancer medication use | Recommended prescription or risk-reducing medications to women age 35 and older who are at increased risk for breast cancer and at low risk for adverse medication effects |
| Cardiovascular disease | Statin use for primary prevention for adults aged 40 to 75 years who have one or more risk factors. Statin use for primary prevention in adults35 |
| Cervical cancer | Recommended screening every 3 years with cervical cytology alone, every 5 years with high risk HPV testing alone, or every 5 years with high risk HPV testing in combination with cytology. |
| Chlamydia and gonorrhea | Screening for all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection11 |
| Colorectal cancer | Screening for adults ages 45-759,21 |
| Depression/anxiety | Screening for depression and anxiety in all adults |
| Diabetes/prediabetes | Screening for prediabetes and type 2 diabetes in adults ages 35 to 70 years who are overweight or obese22 |
| Domestic violence and abuse | Screening for intimate partner violence (IPV) in women of reproductive age and provide or refer women to ongoing support services34 |
| Drug misuse | Screening for unhealthy drug use for individuals 12 years and older25 |
| Fall prevention | Recommended exercise interventions for adults ages 65 or older at increased risk28 |
| Healthy diet and physical activity | Behavioral counseling interventions to promote a healthy diet and physical activity for individuals 18 years an older with risk of cardiovascular disease or a diagnosis of hypertension, dyslipidemia, metabolic syndrome, etc.27 |
| Hepatitis C | Screening for HCV infection in persons at high risk of infection30 |
| HIV | Screening for HIV infection for all adolescents and adults ages 15 to 65. Younger adolescents and older adults who are at increased risk of infection should also be screened. Recommend preexposure prophylaxis (PrEP) to persons at high risk of HIV acquisition. Screening for all adolescents and adults ages 12–65. Recommend preexposure prophylaxis (PrEP) to persons at high risk of HIV acquisition.16 |
| Hypertension | Screening for hypertension in adults 18 years and older with office blood pressure measurement (OBPM). Blood pressure monitoring outside the clinical setting is recommended to confirm diagnosis. |
| Latent tuberculosis infection (LTBI) | Screening for individuals at increased risk of infection33 |
| Lung cancer | Screening for lung cancer annually for individuals ages 50 to 80 years of age with a smoking history of 20 years or more or who have quit within 15 year using low-dose computed tomography31 |
| Obesity | Screening, counseling, and behavioral interventions and offer or refer to comprehensive intensive behavioral intervention to promote improvements in weight status |
| Osteoporosis | Recommended routine screening for osteoporosis with bone measurement testing for women 65 years and older and women younger than 65 who are at increased risk13 |
| Sexually transmitted infections | Behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs).26 |
| Syphilis | Screening for individuals at increased risk for infection12 |
| Tobacco use and cessation | Screening all adults about tobacco use, advise them to stop using tobacco, provide behavioral interventions, FDA approved pharmacotherapy for cessation to nonpregnant adults who use tobacco |
| Urinary incontinence | Annual screening for women. |
For heart health, adults should exercise regularly (at least 30 minutes a day on most days) which can help reduce the risks of coronary heart disease, osteoporosis, obesity, and diabetes. Consult your physician before starting a new vigorous physical activity.
Topics you may want to discuss with your doctor
Nutrition
- Eat a healthy diet. Limit fat and calories. Eat fruits, vegetables, beans, and whole grains every day.
- Optimal calcium intake is estimated to be 1,500 mg/day for postmenopausal women not on estrogen therapy.
- Vitamin D is important for bone and muscle development, function, and preservation.
Sexual health
- Sexually transmitted infection (STI)/HIV prevention,16 practice safer sex (use condoms) or abstinence.
- Prior to beginning PrEP, the following tests are recommended: periodic HIV testing, serologic testing for hepatitis viruses B and C, periodic serum creatinine testing, periodic pregnancy testing, and periodic screening for sexually transmitted bacterial infections.
- Ongoing follow-up, counseling, and monitoring every 3 months is covered without cost sharing.
Mental health and substance use disorder
- Stop smoking. Limit alcohol consumption. Avoid alcohol or drug use while driving.
- Mental health and substance use disorders is defined as those conditions listed in the most recent edition of the World Health Organization (WHO) International Classification of Diseases or in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders.
Dental health
- Floss and brush with fluoride toothpaste daily. Seek dental care regularly.
Other topics for discussion
- Fall prevention.
- Possible risks and benefits of hormone replacement therapy (HRT) for post-menopausal women.
- The dangers of drug interactions.
- Physical activity.
- Glaucoma eye exam by an eye care professional (i.e., an ophthalmologist, optometrist) for those age 65 and older.
Download the complete preventive health guidelines (PDF, 271 KB)
Endnotes
- All children 3 to 5 years are at risk of vision abnormalities and should be screened; specific risk factors include strabismus, refractive errors, and media opacity.
- Annual vaccination against influenza is recommended for all persons age 6 months and older, including all adults.
- Risk factors for hepatitis A should be discussed with your provider.
- Risk factors for hepatitis B should be discussed with your provider.
- For individuals born before 1957 with no evidence of immunity to measles, mumps, or rubella, consider 2-dose series at least 4 weeks apart for measles and mumps or at least 1 dose for rubella. Check with your doctor for details regarding pregnancy.
- Routine vaccination for individuals ages 9-16 years living in dengue endemic areas and have laboratory confirmation of previous dengue infection. Endemic areas include Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, and the Republic of Palau.
- Brief behavioral counseling interventions were found to reduce unhealthy alcohol use in adults 18 years or older, including pregnant women. Effective behavioral counseling interventions vary in their specific components, administration, length, and number of interventions.
- Individuals at risk for meningococcal disease include international travelers or, collegebound students. These individuals should discuss the risks and benefits of vaccination with their doctor.
- Colorectal cancer is the third leading cause of cancer death for both men and women. It is the most frequently diagnosed among persons aged 65 to 74 years. It is estimated that 10.5% of new colorectal cancer cases occur in persons younger than 50 years.
- Individuals at risk for varicella infection include those who have close contact with persons at high risk for severe disease (healthcare workers and family contacts of immunocompromised persons) or are at high risk for exposure or transmission (e.g., teachers of young children; childcare employees; residents and staff members of institutional settings, including correctional institutions; college students; military personnel; adolescents and adults living in households with children; nonpregnant women of childbearing age; and international travelers).
- Risk factors for chlamydia and gonorrhea infection include history of chlamydial or other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, commercial sex work, and drug use.
- Risk factors for syphilis infection include all adolescents and adults who receive health care in a high-prevalence or high-risk clinical setting, men who have had sex with men, commercial sex workers, and those in adult correctional facilities. Individuals being treated for sexually transmitted diseases may be more likely than others to engage in high-risk behavior.
- Osteoporotic fractures, particularly hip fractures, are associated with limitation of ambulation, chronic pain and disability, loss of independence and quality of life. Women have higher rates of osteoporosis than men at any given age.
- Pregnant women who are at high risk for preeclampsia should use low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation.
- People in contact with infants under 12 months of age and healthcare personnel can be given the Td vaccine as soon as feasible. It is recommended that Tdap should replace a single dose of Td for adults under age 65 if they have not previously received a dose of Tdap.
- Sexually transmitted infections, also known as sexually transmitted diseases, include chlamydia, gonorrhea, herpes, HIV, HPV, syphilis, and others.
- The Tdap (tetanus, diphtheria, acellular pertussis) booster is recommended in children ages 11 to 12 who have completed the childhood DTaP immunization series and have not yet received a tetanus and diphtheria (Td) booster dose.
- Children through age 9 getting flu vaccine for the first time – or who received flu vaccine – should get two doses, at least four weeks apart.
- Perform screening of abdominal aortic aneurysm (AAA) with ultrasonography in men who have a history of smoking.
- Your doctor will assess your personal or family history of breast, ovarian, tubal, or peritoneal cancer or family history of breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations. Women with a positive result on the risk assessment tool are recommended to receive genetic counseling and, if indicated after counseling, genetic testing.
- There are several recommended screening tests for colorectal cancer. Your physician will consider a variety of factors to decide which test is best. Screenings include:
- Diabetes/prediabetes screening should be performed for adults ages 35 to 70 who are overweight and obese. Intensive behavioral counseling interventions to promote a healthful diet and physical activity for patients with abnormal blood glucose. Individuals with prediabetes may be referred for preventive interventions.
- Selection of conditions based upon “Newborn Screening: Toward a Uniform Screening Panel and System” as authored by the American College of Medical Genetics (ACMG) and commissioned by the Health Resources and Service Administration (HRSA).
- Fluoride oral supplement should be discussed at preventive care visit if the primary water source is deficient in fluoride.
- Unhealthy drug use screening should be implemented when services for accurate diagnosis, effective treatment, and appropriate care can be offered or referred.
- Behavioral counseling to prevent sexually transmitted infections is for sexually active adolescents and adults at increased risk for sexually transmitted infections.
- Intensive behavioral counseling to promote healthy diet and physical activity is recommended for all adults who have hyperlipidemia or have any known risk factors for cardiovascular and diet-related chronic disease. Diabetes Prevention Program – part of Wellvolution® – is Blue Shield's lifestyle medicine program focused on diabetes prevention.
- Falls prevention counseling for older adults to exercise, or physical therapy to prevent falls in community-dwelling adults age 65 and older who are at increased risk for falls.
- The Advisory Committee on Immunization Practices (ACIP) recommends use of COVID-19 vaccines for everyone ages 6 months and older. COVID-19 vaccine and other vaccines may be administered on the same day.
- Hepatitis C screening for adults 18-79.
- Lung cancer screening for adults ages 50 to 80 who have a 20 pack per year smoking history and currently smoke or quit within the last 15 years.
- Coverage includes:
- prescribed FDA-approved female contraceptive drugs, devices, and products;- device insertion and removal;
- sterilization procedures;
- contraceptive education and counseling including for continued adherence;
- related follow-up services; and management of side effects. For self-administered hormonal contraceptives, you may receive up to a 12-month supply. - Tuberculosis and latent tuberculosis infection (LTBI) for asymptomatic adults at increased risk for infection.
- All women of reproductive age are at potential risk for IPV and should be screened. There are a variety of factors that increase risk of IPV, such as exposure to violence as a child, young age, unemployment, substance abuse, marital difficulties, and economic hardships.
- Statin use for the primary prevention of cardiovascular disease in adults – The USPSTF recommends that adults without a history of cardiovascular disease (CVD) (i.e., symptomatic coronary artery disease or ischemic stroke) use a low- to moderate-dose statin for the prevention of CVD events and mortality when all of the following criteria are met: 1) they are ages 40 to 75; 2) they have one or more CVD risk factors (i.e., dyslipidemia, diabetes, hypertension or smoking); and 3) they have a calculated 10-year risk of a cardiovascular event of 10% or greater. Identification of dyslipidemia and calculation of 10-year CVD event risk requires universal lipids screening in adults ages 40 to 75. Statin medications are a pharmacy benefit.
- High sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year;
- Stool DNA-FIT every 1 to 3 years;
- Computed tomography colonography every 5 years;
- Flexible sigmoidoscopy every 5 years;
- Flexible sigmoidoscopy every 10 years with annual FIT; and
- Colonoscopy screening every 10 years.
Wellvolution is a registered trademark of Blue Shield of California. Wellvolution and all associated digital and in-person health programs, services, and offerings are managed by Solera, Inc., a health company committed to changing lives by guiding people to better health in their communities. These are Blue Shield of California’s Preventive Health Guidelines, which are based on nationally recognized guidelines. Members must refer to their Evidence of Coverage or Certificate of Insurance or Policy for plan/policy coverage of preventive health benefits. Blue Shield of California complies with applicable state laws and federal civil rights laws, and does not discriminate on the basis of race, color, national origin, ancestry, religion, sex, marital status, gender, gender identity, sexual orientation, age, or disability. Blue Shield of California cumple con las leyes estatales y las leyes federales de derechos civiles vigentes, y no discrimina por motivos de raza, color, país de origen, ascendencia, religión, sexo, estado civil, género, identidad de género, orientación sexual, edad ni discapacidad. Blue Shield of California 遵循適用的州法律和聯邦公民權利法律，並且不以種族、膚色、原國籍、血統、宗教、性別、婚姻狀況、性別認同、性取向、年齡或殘障為由而進行歧視。
