So, one thing is – we've
talked about screening exams.
Most exams aren't indicative if
the life expectancy is less than five years,
but I wouldn't just depend –
I've got a chart coming up
which shows you when to consider
stopping these screening tests for cancer.
But in a very vital patient,
don't necessarily think that just because
they have reached the age of 75,
therefore, it's absolutely
the time to stop screening.
Actually, it may be better to
continue to screen those patients.
And in a patient who is 60,
but facing multiple severe illnesses,
with a very poor prognosis,
they don't necessarily need to
go through cancer screening.
They have enough probably going
on in terms of their medical care,
just keeping up with
appointments for multiple specialists,
multiple tests and procedures.
And therefore, the safe thing
is always involve patients
and/or their caregivers in decision-making.
That said, cervical cancer screening,
that one is more of a hard-stop
just because the risk of cervical cancer
among women with previous normal
cervical cancer screening tests is very low.
So, no matter what their level of
vitality and their life expectancy is,
if they have several
normal Pap tests in the past,
I generally will stop cervical cancer screening, age 65.
Age 75 is definitely the year to
stop screening for prostate cancer.
Consideration to stop
screening for colorectal cancer.
You can actually – you can consider
stopping breast cancer screening.
But for a lot of women,
they might go through age 80 or even 85
continuing with breast cancer screening.
So, vaccine is important in the older age group.
Zoster should be given at age 60 years.
The pneumococcal, start with that PCV,
the 13-valent vaccine, age 65.
And then six months after that, you
can apply the 23-valent vaccine.
Influenza vaccine annually.
And continue Tdap vaccine,
especially as these older folks
are exposed to their grandkids.
They can either acquire
or pass along pertussis.
And both of those are high risk groups.
Nobody wants pertussis,
so keep the Tdap vaccine going every 10 years.