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Seniors: Be Prepared When Going for Your Annual Physical

By Michael Lasalandra
Beth Israel Deaconess Medical Center correspondent

When seniors go in for their annual physical exam, they should be armed with a list of questions to ask their doctor, to save time and make sure nothing important is missed.

Doctors say there are a number of issues that those 65 and older should ask about, whether or not they have experienced problems in these areas. On top of these, of course, should be the issues they may be dealing with at the moment.

"It helps to come in with a list," says Dr. Suzanne Salamon, Associate Chief for Clinical Programs in the Division of Gerontology at Beth Israel Deaconess Medical Center. "At the same time, patients have to be realistic. Doctors are under a terrible time crunch. It helps if patients are organized. Establish at the beginning of the visit how much time you have and keep an eye on the clock. Don't spend the whole time on one issue. Move on from issue to issue quickly. It helps the doctor and the patient cover the important things."

Although there has been some controversy over whether an annual physical is necessary, Dr. Salamon says she thinks such an exam "is probably a good idea. You pick up things that might not get caught until later."

Mary Jane Bernier, 68, says she always goes into her doctor's appointments prepared and armed with questions and information for the doctor.

"I'm pretty vigilant about seeing my doctor at least once a year," she says.

While Bernier, a retired nurse, is in excellent health, she says she considers Dr. Salamon a partner in her quest to stay that way as she ages.

"I try and be very proactive and get my issues organized," says the Newton resident. "I try to keep my doctor up to date in terms of what's happening with me, what medications I'm taking and what's going on in my personal life. I try to be efficient with her time. I realize she is my partner in this. She's going to keep me going and needs to know what's happening with me. I always have my questions. And I am proactive about things like mammograms and flu shots and blood work. I realize that aging is part of life, but I am looking for healthy aging.''

Among the most important issues seniors should ask about at their annual exam are blood pressure, cholesterol, bone density, colonoscopies, weight, hearing, vision, mood and flu shots, according to Dr. Salamon.

Blood Pressure

"At age 65, one of the most important things is to make sure your blood pressure is under control," Dr. Salamon says.

A healthy blood pressure of 120/80 should be maintained for life, and if it is higher than that, "it puts you at higher risk of stroke or heart attack," she says.

However, as people get into their 80s and older, higher blood pressure up to even 140s/90 are acceptable because of symptoms such as dizziness and the increased chance of falling that comes both from medication side effects and the aging process itself. Blood pressure can be stabilized with one of a number of medications. If more than one blood pressure medicine is needed, it can be helpful to separate them into morning and evening doses to minimize side effects, she says.

Cholesterol

"We are still in the early stages of trying to figure out the whole cholesterol business, but it appears that those who have very high levels, including high levels of LDL or 'bad' cholesterol, may benefit from taking a cholesterol-lowering drug," Dr. Salamon says. "They can prevent heart attack and stroke."

She recommends starting at a low dose to minimize side effects. A new test for C-reactive protein, which measures inflammation, may also be advised and may help direct who needs cholesterol-lowering medications.

Bone Density

"A bone density scan is very important," Dr. Salamon says. "It's important for men and women, but particularly for women. The test aims to prevent broken bones, particularly hip and spine fractures.

"A hip fracture usually starts a downhill slide. About 25 percent of elderly patients who fracture a hip die within a year. Even among those who survive, many have to walk with a cane or can't live at home. The best treatment is prevention."

Prevention for fractures involves taking adequate calcium, either through food or supplements, plus Vitamin D. If a bone density test shows a problem, there are new medications available to help.

Colonoscopy

The test, which seeks to detect colon cancer early on, should be started at age 50 and then done every 10 years after that.

"A lot of people put it off," notes Dr. Salamon, "as they don't like taking the preparation to clean out the colon in advance of the test. But colon cancer can be treated if caught early."

Hearing

"Older people should get their hearing tested," Dr. Salamon says, noting that hearing loss can be very isolating, particularly when people can't hear the conversations around them. "Sometimes it is just a simple matter of cleaning out ear wax."

If not, hearing aids are very inconspicuous these days.

"People think of hearing aids as a real sign of getting old. But President Clinton had them in both ears in his 50s. Most people don't know that."

Vision

Losing one's sight can be among the most devastating things suffered by the elderly. But glaucoma, a top reason why older people lose their sight, can be prevented, Dr. Salamon says. Annual check-ups at the eye doctor can detect glaucoma, macular degeneration and cataracts.

BMI test

"People have to get their weight under control," she says. "Being overweight is linked to the majority of cases of high blood pressure, high cholesterol and diabetes. A BMI (Body Mass Index) is a calculation of whether someone is at a normal weight for his or her height."

Depression

Unfortunately, most seniors are not receptive to talking about depression, even though it is a real concern later in life. Dr. Salamon suggests family members be on the lookout for signs of depression in their elderly relatives.

"Members of this generation almost never admit to being depressed," she says. "But physical ailments can make you depressed. Depression can mask itself in such complaints as poor appetite, problems sleeping or decreased energy."

Flu Shots

Seniors should get an annual flu shot, says Dr. Salamon. About 35,000 Americans, most of them seniors, die of the flu each year. A pneumonia vaccination is also a good idea. A single shot lasts a lifetime, she says.

Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.

Posted July 2012

Contact Information

Division of Gerontology
Department of Medicine
Beth Israel Deaconess Medical Center
Lowry Medical Office Building #1B (West Campus)
110 Francis Street
Boston, MA 02215
617-632-8696