| Priority problem | Brief recommendation |
| Historical information and counseling | |
| Exercise | Moderate to vigorous aerobic activity 3 to 5 times per week Weight training or resistance exercises to maintain strength Flexibility activities to maintain range of motion Balance training to improve stability and prevent falls |
| Alcohol use | CAGE questionnaire Counseling to stop drinking |
| Tobacco use | Ongoing regular counseling to stop smoking Consideration of pharmacotherapy |
| Medication use | Regular review of medication list for:
|
| Urinary incontinence | Inquire about presence and severity biannually Presence of urinary incontinence should trigger medication review, GU examination, appropriate blood and urine tests |
| Driving | Consideration of driving problems in those with problems with vision, mobility, or cognition For patients with dementia, recommend stop driving or refer for detailed driving assessment |
| Social support | Regular screening for financial and social support |
| Elder mistreatment | Routine direct questioning about problems with abuse or neglect |
| Advance directives | Discussion and documentation of preferences with living will and designation of health care power of attorney |
| Physical examination and testing | |
| Blood pressure | Measure annually If treatment initiated, monitor orthostatic blood pressure, renal function, and electrolytes |
| Weight | Weight loss of 10% or more per year triggers assessment of undernutrition, possible medical or medication-related causes, dental status, food security, food-related functional status, appetite and intake, swallow ability, and previous dietary restrictions |
| Hearing and vision | Annual screening for hearing loss with patient inquiry and examination (whisper test or handheld audiometry) Vision assessment as part of the routine workup for older adults with cognitive decline, functional impairment, or falls |
| Cognition | Targeted screening in patients with memory complaints or new functional impairment with MMSE, Mini-Cog, Clock Drawing Test, Memory Impairment Screen, SLUMS, or MoCA |
| Mood | Screen all older adults for depression with two questions: During the last month:
|
| Gait and balance | Get Up and Go Test |
| Lipids | Screen and treat older adults with CAD risk exceeding 10% over 10 years |
| Bone density | Screening densitometry for osteoporosis for women at age 65 |
| Abdominal aortic aneurysm | One-time screening ultrasound in men aged 65 to 75 with any history of smoking or family history of abdominal aortic aneurysm requiring repair |
| Diabetes | Screen adults (to age 70) with BMI ≥25 kg/m2, hypertension, or hyperlipidemia |
| Cancer screening | |
| Cancer screening | Consider screening for breast, prostate, colorectal, cervical, and lung cancer. Key considerations in older adults:
|
| Immunization | |
| Tetanus-diptheria vaccine | Booster every 10 years in patients who have received primary series (alternative: booster once after age 50); Tdap once |
| Influenza vaccine | Annual vaccination |
| Pneumococcal vaccine | One-time vaccination at age 65 |
| Herpes zoster vaccine | One-time vaccination after age 50 |
| Other | |
| Calcium and vitamin D | 1200 mg of elemental calcium (diet and/or supplement) and at least 800 international units of vitamin D |
