Health care maintenance is aimed to examine the healthy individuals for any asymptomatic disease. It provides an opportunity for prevention in high-risk patients and an early diagnosis with a possibility to prevent advancement of the disease. During a health care maintenance examination (HME), physicians record the medical, social, and family history of the patient along with a comprehensive systemic review to find out relevant risk factors and the necessary screening tests. Preventive societies give guidelines for the screening tests in healthy individuals for health maintenance. Counseling on better nutrition, immunizations, and screening tests are a part of routine HME.
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Image: “Fitness Sprung Gesundheit Frau Mädchen Gesund Fit” by Lazare. License: Public Domain


Health Maintenance for Adults (Age 19–39)

Immunization

Vaccines are a proven way to prevent diseases. Table 1.0 reviews the important immunizations and their frequencies.

Table 1.0. Adult Immunization Schedule

VACCINE AGE (years) FREQUENCY
Influenza 19 to 65
  • Annually
Tetanus, diphtheria, and acellular pertussis vaccination (Td/Tdap) 19 to 65
  • Tetanus, diphtheria, and acellular pertussis vaccination (1 dose) followed by tetanus and diphtheria toxoids booster every 10 years
Measles, mumps, and rubella vaccination, MMR 19 to 59
  • 1 or 2 doses (depending on indication)
Varicella vaccination, VAR 19 to 65
  • 2 doses
Herpes zoster vaccination, HPV (FEMALES ) 19 to 26
  • 3 doses at 0 months, 1–2 months, and 6 months
Herpes zoster vaccination, HPV (MALES ) 19 to 21 3 doses at 0 months,

1–2 months, and 6 months

Screening for hypertension

Adults older than 20 years should be screened for hypertension every two years.

Screening for lipid disorders

Cholesterol screening is recommended every 5 years. Screening begins at the age of 20.

Screening for diabetes

According to the American Diabetes Association, overweight individuals with any two of the following risk factors should undergo screening for diabetes every two years. Screening should begin at the age of 10 or the onset of puberty.

  • One or more first and second-degree relative who are diagnosed as type 2 diabetic
  • People from certain ethnic groups (Native Americans, Asians/South Pacific Islanders, Hispanic Americans, African-Americans)
  • An individual who has signs of insulin resistance
  • People who have conditions that are associated with insulin resistance such as hypertension, acanthosis nigricans, dyslipidemia, polycystic ovary syndrome
Note: Individuals who are not overweight but possess any of the above-given risk factors are also candidates for screening.

Folic acid

Folic acid supplements in the dose of 400–800 mcg should be taken on a daily basis by a woman who is planning or capable of pregnancy.

Screening for domestic violence

Women of childbearing age should be examined for signs of domestic violence. If the screening results are positive, provide help from intervention services.

Screening for alcohol misuse

All adults should be screened for alcohol misuse. If the results are positive, behavioral counseling interventions should be provided.

Screening for tobacco use

Physicians should inquire about the smoking history of adults. Tobacco cessation interventions should be provided to those who are engaged in tobacco use.

Screening for obesity

Screening for BMI should be a part of HME. Sustained weight should be promoted by offering behavior interventions and counseling.

Screening for depression

As per the USPSTF guidelines, the general adult population should be screened for signs of depression followed by required interventions.

Cervical cancer screening

The American Cancer Society provides the following screening guidelines for cervical cancer:

  • Cervical cancer screening should begin for all women at the age of 21
  • Pap test every 3 years is required for women of age group 21–29
  • HPV testing is not recommended as a screening test for this age group
  • Pap test along with an HPV test should be taken for women who are 30 years or older
  • Test interval is every 5 years
  • Co-testing should continue until age 65
  • Those who do not want co-testing can opt for Pap test every 3 years

Chlamydia screening

Women including pregnant females under 25 years of age or those who are older and at a greater risk of catching a chlamydia infection should undergo screening.

HIV screening

USPSTF recommends screening for HIV in all individuals of the age group 15–65.

Additional Screening Tests (Age 40–49)

According to the American Congress of Obstetricians and Gynecologists, annual mammography should be offered to women who are 40 years of age or older.

Screening for prostate cancer in African Americans and other men who have one or more than one first-degree relative who was diagnosed with prostate cancer at an early age.

Additional Screening Tests (Age 50+)

Breast cancer screening

USPSTF recommends biennial mammography screening for breast cancer beginning at the age of 50.

Bone mineral density (BMD) screening in women aged 65 or above. Women who are less than 65 should only be screened if they have a significant risk of osteoporosis or bone fractures.

Hepatitis C screening

It is for individuals born between the years 1945-1965.

Ischemic stroke

If the benefit for ischemic stroke reduction is more than the risk of GI hemorrhage, aspirin 75mg O.D should be prescribed to women of the age group 55-79.

PVC13 & PPSV23

PVC13 is recommended for individuals who are 65 years or older and immunocompetent. PVC13 should be followed by PPSV23 at least 1 year afterward.

Older adults who are 60 or above should receive 1 dose of herpes zoster vaccine irrespective of previous vaccination or disease history.

Colorectal cancer screening

The AAFP recommends screening for colorectal cancer at the age of 50 years and continuing until the age of 75 years. The preferred tests are:

  • Fecal immunochemical tests
  • Flexible sigmoidoscopy
  • Colonoscopy starting

Lung cancer screening

According to the U.S. Preventive Services Task Force recommendations, following people should undergo yearly lung cancer screening with LDCT:

  • Individuals with a history of heavy smoking
  • Individuals who are smokers or have quit smoking within the past 15 years
  • 55 and 80 years old individuals
  • 55 to 80 years old individuals with ≥ 30 pack-year smoking history and smoking cessation within less than past 15 years

Prostate cancer screening

For those men who are 55 to 69 years old, the decision to undergo PSA screening involves weighing the benefits and risks. The guidelines for age group 55 to 69 years are based on weighing the pros and cons of PSA screening.

Other than the mentioned screening tests, a health care exam (HME) should be carried out every 5 years for adults aged 18 to 39 years and every 2-3 years for the age group 40-49. People who are 50 plus should have their HME every 1-2 years.

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