Immunizations / Screening in Older Adults
Immunizations in Adults 65+ (AGS Guide) - Strongly Recommended
Vaccine |
Schedule |
Talking Points |
|---|---|---|
| COVID-19 | > 65 or older should receive at least two doses yearly | Effective against severe illness, hospitalization, and death |
| Hepatitis B | Routine for adults < 60, can offer to adults > 60 with or without risk factors or HBV | Protects against Hep B for 20 yrs – life, effective for 80-100% of people. Can prevent liver disease and HCC from Hep B. |
| Influenza | Yearly | Effective against death and hospitalization |
| Pneumococcal | >50 or older should receive one dose of PCV21 (conjugate) OR PCV20 (conjugate) OR PCV15 (conjugate) followed by PPSV23 (polysaccharide) one year later | Pneumococcal disease most often occurs in older adults and in those with predisposing conditions and may occur in the lungs, brain, or blood. PCV21 and PCV20 protects against more types of pneumococcal bacteria than PCV13 |
| Recombinant Zoster | Two doses (second dose administered 2-6 months after the first) | Reduces risk of herpes zoster by over 90% and postherpetic neuralgia by 85% |
| RSV | Yearly | Benefits: reduced outpatient RSV lower respiratory tract disease by 82-89% in one season Harms: Serious neurological inflammatory events (GBS) in a handful of study participants Unknowns: insufficient data on efficacy and safety in people 75 years or older, persons who are frail, and persons who reside in long term care facilities. Vaccines have not shown to prevent hospitalizations in older adults |
| Tdap | Every 10 years | recommended that all adults over age 65 get Tdap to help reduce spread of whooping cough to others, such as grandchildren |
Cancer Screenings in Adults 65+ (AGS Guide)
- Consider a patient’s remaining life expectancy, comorbidities, risk of disease, preferences, cognitive and functional status when deciding which preventative measures to offer.
- Cancer screenings below are not recommended for older adults with at least moderate dementia or those near the end of life
- Older adults are generally open to conversations about stopping cancer screenings, especially when coming from a physician whom they trust.
- Work by Nancy L. Schoenborn recommends framing these conversations around age, health status, and helping people live longer but showed discussing life expectancy in this context can be controversial.
- Most compelling reason to stop screening: “this test would not help you live longer” instead of “you may not live long enough to benefit from this test”
- UCSF Time to Benefit Calculator can help determine which interventions could potentially benefit or harm your patient
Resource: UCSF ePrognosis Score https://eprognosis.ucsf.edu/time_to_benefit.php
Screening |
Cessation Guidance |
|---|---|
| Mammogram (every 2 years)* | Consider at age 75 |
| Pap Smear* | Stop at age 65 |
| Colon Cancer (yearly for fecal occult blood test or every 10 years with colonoscopy)* | Shared decision-making ages 76-85 Stop at age 86 |
| Lung Cancer (annually in those at risk) | Stop at age 75-80 |
| *Not recommended for persons with < 10 years remaining life expectancy | |
Other Screenings in Adults 65+ who are NOT at the end of life (AGS Guide)
- DEXA screening: at least once after age 65 in women or age 60 if high risk
- Consider if not done previously and life expectancy 5 to < 10 years
- TTB ~ 13 months so would consider in those with life expectancy > 2 years *(difference from AGS guide)
- Not recommended for persons with moderate dementia
- Blood glucose: screen if patient likely to benefit; consider stopping at age 70
- Not recommended for persons with < 10 years remaining life expectancy or moderate dementia
- Cholesterol: Screen those with additional risk factors (smoking, DM, HTN, 10 year CVD event risk >10%) up to age 75
- Consider if life expectancy 5 to < 10 years
- Not recommended for persons with moderate dementia
- Ultrasonography for AAA: once for men 65-75 who ever smoked, can consider in men who never smoked
- Consider if life expectancy 5 to < 10 years
- Not recommended for persons with moderate dementia
- HIV: consider for those at high risk
- Hepatitis B: consider for those at high risks
- Hepatitis C: once for those born 1945-1965