History and counseling | | | |
• Substances | Smoking14 Alcohol15,16: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances17 | Smoking Alcohol: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances | Smoking Alcohol: ≤ 10 drinks/wk for women, ≤ 15 drinks/wk for men Other substances |
• Physical activity | 150 min/wk moderate or vigorous intensity18 (cannot say more than a few words without pausing for breath) | 150 min/wk moderate or vigorous intensity (cannot say more than a few words without pausing for breath) | 150 min/wk moderate or vigorous intensity (cannot say more than a few words without pausing for breath) |
• Diet and nutrition | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt19 | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt | Fruit, vegetables, whole grains, healthy fat, ≤ 2000 mg/d of salt |
• Sun exposure | Protective clothing, sunscreen20 | Protective clothing, sunscreen | Protective clothing, sunscreen |
• Sexual activity | Safe sex and STI counseling21 (Screen for chlamydia and gonorrhea annually until age 25 y if sexually active and beyond age 25 y if high risk) | Safe sex and STI counseling if high risk | Safe sex and STI counseling if high risk |
• Advance directives | | | Discuss once22 |
• Supplements | Vitamin D: 400–2000 IU/d23 Calcium: 1000 mg/d from diet24; 1500–2000 mg/d if pregnant or lactating25 | Vitamin D: 1000–2000 IU/d Calcium: 1200 mg/d mainly from diet | Vitamin D: 1000–2000 IU/d Calcium: 1200 mg/d mainly from diet |
• Physical examination* | BP,26 height, weight, BMI,27 WC28 If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss | BP, height, weight, BMI, WC If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss | BP, height, weight, BMI, WC If obese (30 kg/m2 ≤ BMI < 40 kg/m2) offer or refer to structured behavioural interventions aimed at weight loss |
Investigations and screening tests | | | |
• Cognitive | | | Screen if a family member is concerned29; memory complaints should be evaluated and followed to assess progression |
• Falls | | | Ask about trips or falls in past year or fear of falling30 |
• STI | Gonorrhea and chlamydia31 VDRL, HIV, and HBV if high risk | Gonorrhea and chlamydia VDRL, HIV, and HBV if high risk | Gonorrhea and chlamydia VDRL, HIV, and HBV if high risk |
• Diabetes† | Assess HbA1c level if FINDRISC score > 1432 | Assess HbA1c level if FINDRISC score > 14 | Assess HbA1c level if FINDRISC score > 14 |
• Lipid levels‡ | Risk assessment32 Screen men ≥ 40 y | Risk assessment Screen women ≥ 50 y or menopausal | Risk assessment |
• Vision | 19–40 y every 10 y33; 41–49 y every 5 y unless high risk (African American, high myopia, diabetes, or hypertension) | 50–55 y every 5 y; 56–64 y every 3 y unless high risk (African American, high myopia, diabetes, or hypertension) | Annually |
• Colon cancer | | FIT or FOBT every 2 y or flexible sigmoidoscopy every 10 y34 | FIT or FOBT every 2 y or flexible sigmoidoscopy every 10 y until 75 y |
• Osteoporosis | | Screen based on risk factors | Screen women and men once > 65 y35 |
• Immunizations§ | Td, Tdap, HPV, MMR Pneumococcal, influenza, varicella, polio, meningococcal conjugate36–38 | Td, Tdap, pneumococcal influenza, herpes zoster, varicella, polio | Td, Tdap, pneumococcal, influenza, herpes zoster, varicella, polio |
Women | | | |
• Family planning | Folic acid: 0.4–1 mg/d at childbearing age39 Rubella serology40 | | |
• Cervical cancer | Start at age 25 y if sexually active,‖ every 3 y if results are normal41 | Every 3 y if results are normal | Every 3 y if results are normal; stop at age 69 y if 3 normal results in past 10 y |
• Breast cancer | | Mammogram every 2 y42 | Mammogram every 2 y; stop at age 75 y |
Men | | | |
• AAA screen | | | Abdominal ultrasound once at age 65–75 y in patients who have ever smoked43 |