Dr Kevin McCarroll
Medical Matters
Doctors are often asked to do blood tests or checks on people as they get older to make sure all is well and give reassurance to their patients. The old adage of “prevention is better than cure” is so true and indeed early detection and treatment can also make a big difference. However, in a healthcare system under pressure, sometimes the “worried well” might end up getting unnecessary tests and in recent years there has also been a number of private providers offering health screens to adults of varying ages.
So who should get checked and what tests should be considered as one gets older? There are a number of basic tests that should be considered and then are those that are targeted to people who are higher risk of certain conditions.
For example, everyone from the age of 40 should have their blood pressure checked at least annually as this is a silent cause of heart and stroke disease. It has also been recommended to check blood pressure every three to five years in those under 40 and more frequently if you’re young and overweight.
You should get tested for diabetes or pre-diabetes if you are overweight, have a family history or have symptoms and this can be repeated every three years.”
Cholesterol is determined not just by diet but in fact about 70% is dependent on your metabolism and genetics. For this reason, you should consider getting your cholesterol checked in your 20’s and then every five years .
You should get tested for diabetes or pre-diabetes if you are overweight, have a family history or have symptoms and this can be repeated every three years.
In those with a strong family history of coronary disease, or who have other risk factors like heavy smoking then an exercise stress test can be considered. It involves running on a treadmill with heart monitoring. However, in those with significant but non-occlusive coronary disease the test can be negative. In addition, its primary role is in assessing patients who have symptoms of chest pain. In those with moderate to high risk of heart disease then a screening CT coronary angiogram can be done which is a non-invasive test that allows visualisation of the coronary arteries. It involves injecting a dye into a vein in your arm followed by CT imaging which identifies the degree of plaque and narrowing in the blood vessels. When significantly abnormal, it may need to be followed up with further tests.
An irregular heart rate (atrial fibrillation) occurs in about 10% of those over 65 and is a major cause of stroke. If you’re visiting your GP it’s a good idea to get them to check for this as in many cases there are no symptoms and treatment with blood thinners reduces your stroke risk by about 70%.
Screening for cancer has been the topic of much recent discussion. Breast cancer screening with mammography is available every two years from the ages of 50-67 .
Breast cancer screening with mammography is available every two years from the ages of 50-67.”
You can also get checked for prostate cancer (usually in men aged 50+) with the PSA blood test which is raised in about 80% of cancer cases. However, in older men it may also be elevated due to benign prostate enlargement sometimes leading to unneccesary tests. Despite this, in healthy men checking a PSA can identify cancer at an early stage when curative therapy can be given. Indeed, many men have received treatment on foot of PSA screening who would otherwise had their cancer potentially diagnosed much later. Furthermore, having a baseline PSA level to monitor for future change may be useful.
Screening for bowel cancer is provided by the HSE every two years for those between the ages of 60-69. It involves collecting a small sample of stool and sending it to a laboratory to test for occult blood. About 5% will have an abnormal result and some will need further tests. If you have a first degree relative (parent or sibling) who was diagnosed with colorectal cancer before the age of 60, then screening with a colonoscopy (camera test of bowel) should be considered.
An aneurysm or a bulge in the aorta (the main artery in the body) occurs in up to 8% of men aged 65+, can increase in size and sometimes rupture. Guidelines vary but screening with a simple ultrasound has been recommended in men aged 65+ and should also be considered in those who are younger with a family history or who smoke and have high blood pressure.
If you are female and 65+ or male and 70+, you should consider getting a DXA to assess for brittle bones.”
If you are female and 65+ or male and 70+, you should consider getting a DXA to assess for brittle bones. A DXA may need to be done earlier if there are other risk factors such as alcohol excess, smoking and a family history or if you have a fracture from minimal trauma. Finally, if you have a family history of glaucoma you should get your eyes checked every three years by your optician starting from the age of 40.
As always, you should be vigilant for any changes in your body or new persistent symptoms that should prompt you to visit your GP.