M&D Clinical Corner: Healthy Aging Month

The Clinical Corner is a monthly feature that highlights a variety of important pharmacist topics that is written by Dr. Jesica Mills, PharmD, ND, MBA, RPh, BCES, BCLS, BCNP.

Screenings and Supplementation Support

As pharmacists working in various healthcare settings, staying up-to-date on the latest guidelines for preventative screenings and supplementation is essential to supporting your patients’ health. September, designated as Healthy Aging Month, serves as a reminder to ensure your patients are receiving the appropriate preventative care as they age. With recent updates to healthcare guidelines, now is the time to brush up on new recommendations and highlight the changes that have occurred in the last six months.

Preventative Screening Updates by Patient Group

Children and Adolescents (birth to 18 year)

• Routine Vaccinations: The back-to-school season is an opportunity to ensure that children are caught up on missed vaccines. The CDC’s recommended vaccine schedules should be prominently displayed to facilitate discussions with parents.
  • You can also answer patient questions about which vaccines their child needs by taking the quiz here. You can also utilize your social media accounts and website by including that link and encouraging your patients to take the quiz.
• Vision and Hearing Screenings: These remain critical for children, especially as early detection can prevent long-term issues with learning and development.
  • Vision screening timeline:
    • At birth: A basic eye exam is performed to check for any major eye problems or abnormalities.
      6 months to 1 year: The first comprehensive vision screening is typically done between 6 and 12 months.
    • Ages 3 to 5: The next vision screening should occur at least once between the ages of 3 and 5 to check for any potential vision problems like lazy eye (amblyopia).
    • School-age (6+ years): After starting school, vision should be screened every 1-2 years during routine well-child visits or as recommended by a healthcare provider.
  • Hearing Screening timeline:
    • At birth: Newborns should have a hearing screening before leaving the hospital or within the first month.
    • Ages 4, 5, 6, 8, and 10: The American Academy of Pediatrics recommends hearing screenings at these ages to catch any issues that could affect learning and development.
    • As needed: Additional screenings may be necessary if a child shows signs of hearing difficulty or is at higher risk due to family history, ear infections, or other conditions.
  • Cholesterol levels:
    • Ages 9-11: The American Academy of Pediatrics recommends all children have their cholesterol levels checked once between ages 9 and 11.
    • Ages 17-21: A follow-up screening should be done between 17 and 21
    • Lead Exposure: Screening for lead poisoning at ages 1 and 2, especially in high-risk areas or older homes.
    • Anemia: Hemoglobin or hematocrit tests are typically performed around 12 months and as needed
    • Blood Pressure: Start screening for elevated blood pressure around age 3.
    • Dental Health: Regular dental visits to screen for cavities and gum disease start at preschool and school age (starting at age 4-5)
    • Diabetes Screening: Screen adolescents age 13-18 who are overweight or have other risk factors for type 2 diabetes.
    • Sexual Health Screening: Regular STI screenings for sexually active teens and education about safe practices.
    • Mental Health Screening: Annual checks for anxiety, depression, and risk of suicide.
    • Substance Use: Screening for alcohol, tobacco, and drug use in ages 13-18.
    • Scoliosis: Screening during growth spurts, particularly around ages 10-16.
    • Celiac Disease: If there is a family history of autoimmune disorders or symptoms like chronic diarrhea, failure to thrive, or abdominal pain.
    • Thyroid Function: If there are risk factors like family history of thyroid disorders or symptoms of hypothyroidism/hyperthyroidism.
• Supplement Recommendation:Multivitamins/Minerals for children can help fill nutrient gaps, particularly in the context of rapid growth or dietary limitations. There are many different forms available that can meet all kids needs- including liquid (Mary Ruth vitamin brand), patches (PatchAid), gummies (Smartypants brand) to name a few.

Young Adults (Ages 18-39)

• Blood Pressure Screening: Every 2 years if your blood pressure is normal (<120/80 mm Hg); annually if higher.
• Cholesterol Screening: Every 4-6 years starting at age 20 for those at average risk. More often for those with risk factors like obesity, diabetes, or a family history of heart disease.
• Type 2 Diabetes Screening: At least every 3 years starting at age 35, or earlier if overweight/obese and have additional risk factors.
• Sexually Transmitted Infections (STI) Screening: Annually for sexually active adults, especially for chlamydia, gonorrhea, and HIV.
• Pap Smear/Cervical Cancer Screening (Women): Every 3 years starting at age 21, or every 5 years with HPV testing if preferred. This screening recommendation goes until a woman is 65.
• Breast Cancer Screening (Women): Clinical breast exams every 1-3 years starting in your 20s and 30s. Mammograms usually begin at age 40 unless there are risk factors.
• Testicular Cancer Screening (Men): Self-exams monthly; discuss regular checkups with a doctor, especially in men aged 18-35.
• Prostate-Specific Antigen (PSA) Screening (Men): Recent guidelines suggest men at higher risk (African American men or those with a family history of prostate cancer) may consider PSA testing starting at age 40. For other men, PSA screening often begins after age 50.
• Mental Health Screening: Annually or as needed.
• Alcohol and Substance Abuse Screening: Annually or at routine checkups.
• Immunizations:
  • Tetanus, Diphtheria, Pertussis (Tdap): Once, then Td booster every 10 years.
  • HPV Vaccine: Complete the series by age 26 if not done earlier.
    • Pharmacists should continue to promote the HPV vaccine, especially for young adults, as the CDC recently broadened its recommendations for use up to age 45.
  • Influenza: Annually.
  • Other Vaccines: MMR, Hepatitis B, and others if needed based on individual risk.
• Dental Health: Every 6 months for dental exams and cleanings.
• Eye Exam: Every 2 years if no vision problems; annually if you wear corrective lenses or have conditions like diabetes or glaucoma.
• Hearing Screening: At least once in your 20s and once in your 30s, or more frequently if you notice hearing loss.
• Skin Cancer Screening: Perform regular self-exams and get a clinical exam if you have risk factors like fair skin, frequent sun exposure, or family history of skin cancer.
• Bone Health: Screen for risk factors like family history, low body weight, or certain medications. Regular screening for women at higher risk starting in their 30s.
• Risk-Based Screenings (Depending on Personal/Family History)
  1. Thyroid Function: Screen if there are symptoms of thyroid dysfunction (fatigue, weight changes, temperature sensitivity) or a family history of thyroid disease.
  2. Colon Cancer Screening: Typically starts at age 45, but individuals with a family history of colorectal cancer or other risk factors may need to start earlier.
• Supplement Recommendation: Omega-3 Fatty Acids from fish oil can help support cardiovascular health. Recommended to take at bedtime and consume 1-3 g of EPA/DHA.

Middle-Aged Adults (Ages 40-59)

• All the above plus those listed below
• Prostate-Specific Antigen (PSA) Testing Update: Recent guideline changes recommend starting PSA screenings for prostate cancer earlier—at age 45 for men at high risk, including African American men and those with a family history of prostate cancer. This change reflects growing evidence that earlier detection can improve outcomes.
• Mammograms: The USPSTF continues to recommend mammograms starting at age 40, and it’s crucial to educate patients on the importance of early detection. Repeat mammograms every 1-2 years.
• Colorectal Cancer Screenings: The starting age for colorectal cancer screening has been lowered to 45 years old for all adults, per updated guidelines from the American Cancer Society. Screen every 10 years or stool test annually, unless and until an abnormal colonoscopy or result from a stool test.
• Hearing tests: Every 3-5 years or as needed if there are signs of hearing loss.
• Thyroid function test: Every 5 years, or more frequently if symptomatic or if there’s a family history of thyroid disease.
• Immunizations:
  • Tetanus, Diphtheria, Pertussis (Tdap): Booster every 10 years.
  • Shingles Vaccine (Zoster): Two-dose vaccine starting at age 50.
  • Pneumonia Vaccine: Depending on risk factors like chronic illness, smokers, or immunocompromised individuals.
  • Influenza: Annually.
• Supplement Recommendation: CoQ10 is beneficial for middle-aged patients, especially those on statin medications, as it supports energy production and reduces the risk of statin-related muscle pain. Recommended to take 100mg daily if taking a statin once daily.
• Risk-Based Screenings (Depending on Personal/Family History)
  • Abdominal Aortic Aneurysm (AAA) Screening (Men with history of smoking):
    • Frequency: One-time ultrasound screening between ages 65-75 for men who have smoked.
  • Lung Cancer Screening (For Smokers):
    • Frequency: Annual low-dose CT scan for adults aged 50-80 who have a 20-pack-year smoking history and currently smoke or have quit within the last 15 years.
  • Coronary Artery Calcium (CAC) Scan:
    • May be considered for those at high risk of heart disease.
  • Sleep Apnea Screening:
    • For individuals experiencing symptoms such as loud snoring, daytime sleepiness, waking up with headaches in the morning, or interrupted sleep.

Older Adults (60+ years)

• Blood Pressure: Moves to testing at least annually if under 120/80.
• Type 2 Diabetes: Moves to annually
• Colorectal Cancer: Every 10 years with colonoscopy, every 3 years with flexible sigmoidoscopy, or annually with stool-based tests, continuing until age 75.
• PSA: Annually for men aged 55-69; individual decisions should be made after age 70.
• Breast Cancer: Mammograms every 1-2 years for women up to age 75; frequency should be based on personal health and risk factors after that.
• Pap Smear/Cervical Cancer: Women aged 65 and older may stop screening if they’ve had regular screenings in the past 10 years with no abnormal results. Continue as recommended if at higher risk.
• Eye Exam: Annually, especially for those with diabetes or at risk for cataracts, glaucoma, or age-related macular degeneration.
• Hearing: Every 1-3 years or as needed if hearing loss is suspected.
• Mental Health: Annually or as needed, especially for depression, anxiety, and cognitive decline (Alzheimer’s or dementia screening).
• Thyroid testing: Every 5 years or more frequently if there are symptoms of thyroid dysfunction (e.g., fatigue, weight changes, mood swings).
• Abdominal Aortic Aneurysm (AAA): One-time ultrasound screening for men aged 65-75 who have ever smoked.
• Bone Density Testing: The National Osteoporosis Foundation advises routine bone density scans for post-menopausal women and men over age 65 to prevent fractures related to osteoporosis.
• Vaccinations for Older Adults: Shingles and pneumonia vaccines remain critical for this age group. Pharmacists should also encourage flu vaccines and educate patients about the newly available RSV vaccine for adults over 60.
• Lung Cancer Screening: Recent changes now recommend annual lung cancer screenings for patients aged 50-80 who have a significant smoking history.
• Peripheral Artery Disease (PAD): As recommended by your doctor if there is a history of smoking, diabetes, or heart disease.
• Hepatitis C Screening: One-time screening for adults born between 1945 and 1965, or anyone at risk.
• Supplement Recommendation: Vitamin D and calcium are essential for maintaining bone health, especially for post-menopausal women and older adults with low sun exposure. Recommended to take the active form of D3/K2 at 1000iu daily, and at least 600mg of Calcium daily (my favorite salt form of Calcium is Calcium citrate).

Recent Updates in Healthcare Guidelines

Several key changes to healthcare guidelines have emerged in the last six months, which pharmacists should take note of:

1. PSA Testing Now Recommended for Younger Men at Risk: The American Urological Association (AUA) has updated its recommendation for PSA screening to begin at age 45 for men at high risk, including those with a family history of prostate cancer and African American men. This is a shift from the previous guideline, which recommended starting at age 50 for most men.
2. Colorectal Cancer Screening Age Lowered to 45: Both the American Cancer Society and USPSTF have lowered the recommended starting age for colorectal cancer screening to 45 years from 50 due to rising rates of colorectal cancer in younger adults.
3. RSV Vaccine Now Available for Adults 60+: In a significant update, an RSV vaccine has been approved for adults over 60, addressing the increased vulnerability of older adults to respiratory illnesses. Pharmacists should stay informed on its availability and recommend it to patients as needed.
4. Expanded HPV Vaccination Guidelines: The CDC has broadened the recommended age range for HPV vaccination up to age 45. Pharmacists should actively educate adults who may not have received the vaccine in their younger years about the benefits of receiving it now to prevent HPV-related cancers.

The Role of Pharmacists in Facilitating Preventative Health

As front-line healthcare professionals, pharmacists are uniquely positioned to promote preventive health through education, screenings, and supplements. Here’s how you can integrate these practices into your workflow:

1. Use Vaccine Assessment Tools: The Adult Vaccine Recs from the CDC remains an excellent tool for identifying which vaccines patients may need. Keep it readily available to assist patients in assessing their immunization status.
2. Encourage and Offer Preventative Screenings: Many patients are unaware of updated guidelines, so pharmacists should proactively engage with patients about their eligibility for screenings like PSA tests, mammograms, and colonoscopies.
3. Stock Preventative Health Supplements: Carry and recommend supplements such as Vitamin D3/K2, CoQ10, and Omega-3s. Offering these supplements alongside educational material can support patients in maintaining their health between screenings.
4. Automate Follow-Ups and Reminders: Implement automated scheduling systems and reminders for patients who need regular screenings or vaccinations. An efficient follow-up system allows you to stay engaged with your patients and help them stay on track with their preventative health measures.

Conclusion

September’s Healthy Aging Month offers pharmacists an opportunity to educate patients and ensure they are receiving the preventative care and screenings they need. By staying current on recent updates to screening guidelines and vaccination recommendations, pharmacists can play a crucial role in promoting long-term health for their patients across all age groups. Continue to stay informed, stock essential supplements, utilize technology in scheduling and documenting their screening dates and results, and create an environment where patients feel comfortable discussing their health needs with you.