Elderly Women (> 65 years) Quick Table: All Relevant Recommendations
PPlease note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.
Quick Table of All Recommendations Specific and Relevant to Elderly Women (> 65 years)
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| "A" Recommendations | ||
| Breast cancer | Mammography and clinical exam | Women aged 50-69 yrs |
| Cognitive Impairment | Follow-up based upon caregiver or informant description of decline | Elderly |
| Colorectal cancer | Multiphase screening with the Hemoccult test | Average risk adults > age 50 |
| Dental caries, periodontal disease | Brushing and flossing teeth to apply toothpaste (A) and prevent gingivitis (B) but not cariostatic (C) | General population |
| Falls/injury | Multidisciplinary post-fall assessment | Elderly |
| Household and recreational injury | Public education/ Legislation on poison control | General population |
| Hypertension | Pharmacologic treatment | Elderly, specific subgroups |
| Influenza | Outreach strategies to reach high-risk groups | Specific groups (e.g., diabetics), elderly |
| Influenza | Influenza vaccination | General population |
| Influenza | Neuraminidase inhibitor prophylaxis | General population |
| MVA injury | Legislation, restraint use and control of drinking and driving | General population |
| Oral cancer mortality | Smoking cessation counselling | General population |
| Osteoporotic fractures | Screening using the SCORE or ORAI to predict low BMD | Postmenopausal women |
| Osteoporotic fractures | Secondary prevention of vertebral fractures using alendronate | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of vertebral fractures using alendronate | Postmenopausal women |
| Periodontal disease | Flossing teeth | Adult population |
| Pneumococcal pneumonia | Single dose of 23-valent pneumococcal vaccine | Immunocompetent patients >age 55 years in institutions |
| Progressive renal disease | Urine dipstick | Adults with IDDM |
| Tobacco-caused disease | Counselling, smoking cessation or offer nicotine replacement therapy | Smokers |
| "B" Recommendations | ||
| All-cause mortality and morbidity | Moderate physical activity | General population |
| Cervical cancer | Papanicolaou smear | Women |
| Cognitive Impairment | Assessment based upon individual's complaint of memory loss | Elderly |
| Colorectal cancer | Sigmoidoscopy | Average risk adults > age 50 |
| Colorectal cancer | Flexible sigmoidoscopy beginning at puberty, genetic testing | High-risk adults with FAP |
| Colorectal cancer | Colonoscopy | High-risk adults with HNPCC |
| Diet-related illness | Counselling on adverse nutritional habits | Adult population |
| Diminished visual acuity | Snellen sight card | Elderly |
| Falls prevention in long-term care facilities | Multifactorial screening and intervention program | Elderly |
| Gingivitis | Brushing teeth | General population |
| Gonorrhea | Counselling, Educational materials | General population |
| Hearing impairment | Enquiry, whispered voice test or audioscope | Elderly |
| Household and recreational injury | Legislation, safety aids, stairs, bathtubs | Elderly |
| Household and recreational injury | Legislation, window and stair guards, smoke detectors | General population |
| Household and recreational injury | Public education/ Legislation, fire burn and water (tub and swimming) safety | General population |
| Household and recreational injury | Legislation, avoidance of alcohol with water recreation | General population |
| Hypertension | Blood pressure measurement | Elderly |
| Influenza | Immunization, annual | Elderly |
| Lung cancer | Dietary advice on green leafy vegetables and fruit | Smokers |
| MVA Injury | Counselling on restraint use and avoidance of drinking and driving | General population |
| Obesity | BMI measurement | Obese adults with obesity-related disease |
| Obesity | Weight-reduction therapy | Obese adults with obesity-related disease |
| Osteoporotic fractures | Screening | Postmenopausal women |
| Osteoporotic fractures | Screening using individual risk factors | Postmenopausal women |
| Osteoporotic fractures | Screening using BMD to predict fractures | Postmenopausal women |
| Osteoporotic fractures | Primary prevention of fragility fractures using calcium and vitamin D | Postmenopausal women |
| Osteoporotic fractures | Secondary prevention of vertebral fractures using risedronate or raloxifene | Postmenopausal women |
| Osteoporotic fractures | Secondary prevention of hip and nonvertebral fractures using alendronate or risedronate | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of vertebral fractures using raloxifene, risedronate, etidronate, or oral pamidronate | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of hip fractures using alendronate | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of hip and nonvertebral fractures using risedronate | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of vertebral and nonvertebral fractures using PTH | Postmenopausal women |
| Periodontal disease | Tooth scaling and prophylaxis | General population |
| Problem drinking | Case finding and counselling | General population |
| Skin cancer | Counselling, sun exposure, clothing | General population |
| Stroke | Anticoagulation if atrial fibrillation detected after stroke | Patients with paroxysmal atrial fibrillation |
| Stroke | Anticoagulation (warfarin) for intracardiac thrombus to prevent systemic emboli | Patients with stroke and intracardiac thrombus |
| Stroke | Echocardiography: Transthoracic (TTE) or transesophageal (TEE) for detection of intracardiac masses | Patients with clinical cardiac disease and no pre-existing indications for anticoagulation |
| Tobacco-caused disease | Referral to validated cessation program | Smokers |
| Vehicle-related injury | Legislation, bicycle motorcycle or all terrain vehicle helmet | General population |
| "C" Recommendations | ||
| Abdominal aortic aneurysm | Abdominal palpation | General population |
| Abdominal aortic aneurysm | Abdominal ultrasound | General population |
| Adverse consequences, children of alcoholics | Routine evaluation; some screening options | General population |
| Age-related macular degeneration | Fundoscopy | Elderly |
| All-cause mortality and morbidity | Counselling, physical activity; prevent obesity | General population |
| All-cause mortality, morbidity | Measure body mass index and treat obesity | General population |
| Breast cancer follow-up | Follow-up for local recurrence | Women having been previously diagnosed with breast cancer |
| Breast cancer follow-up | Follow-up for contralateral breast cancer | Women having been previously diagnosed with breast cancer |
| Cardiovascular disease | Acetylsalicylic acid prophylaxis | General population |
| Cognitive impairment | Mental status screening | Elderly |
| Colorectal cancer | Hemoccult/sigmoidoscopy in combination | Average risk adults > age 50 |
| Colorectal cancer | Colonoscopy | Average risk adults, high-risk adults with family history of polyps/CRC |
| Coronary artery disease events | Screening for total plasma homocysteine levels | General population or those at high risk for coronary artery disease events |
| Coronary artery disease events | Vitamin therapy (folic acid alone or with vitamin B12) to lower total plasma homocysteine levels | All populations |
| Coronary heart disease | Diet/drug treatment | Individuals with elevated cholesterol or LDL-C except males 30-59 yrs |
| Coronary heart disease | Measurement of blood total cholesterol level | General population with case-finding for males 30-59 years |
| Coronary heart disease | General dietary advice on fat and cholesterol | General population except males 30-69 years |
| Elder abuse | Elder abuse questionnaire | Elderly |
| Glaucoma | Fundoscopy, tonometry or automated perimetry | Elderly |
| HIV/AIDS | History, sexual and drug use counselling | General population |
| HIV/AIDS | Voluntary HIV screening | General population including pregnant women |
| Household and recreational injury | Monitor medical impairment | Elderly |
| Household and recreational injury | Public education/ Legislation, gun control and use of Heimlich maneuver | General population |
| Household and recreational injury | Counselling, household and recreational injury (except some home hazards) | Adult population |
| Household and recreational injury | Public education, non-flammable fabrics, self-extinguishing cigarettes | Elderly |
| Iron deficiency anemia | Routine hemoglobin | General population |
| MVA injury | Counselling, helmet, alcohol use | General population |
| MVA injury | Monitor medical impairment | General population |
| Obesity | BMI measurement | General population |
| Obesity | Community-based obesity prevention programs | General population |
| Obesity | Weight-reduction therapy | Obese adults without obesity-related disease |
| Oral cancer | Physical exam, oral cavity | General population |
| Oral cancer mortality | Opportunistic screening by clinical examination | Asymptomatic patients |
| Ovarian cancer | Pelvic exam, transvaginal ultrasound, CA 125 or combination | High-risk women with > 1 first-degree relative with ovarian cancer |
| Pneumococcal pneumonia | Immunization, one dose | Immunocompetent elderly living independently |
| Protein/calorie malnutrition | Protein/calorie malnutrition screening | Adult population |
| Skin cancer | Counselling, Skin self-examination | General population |
| Skin cancer | Counselling, Sun block | General population |
| Skin cancer | Physical examination, skin | General population |
| Stroke | Ambulatory ECG | All patients presenting with stroke or transient ischemic attack |
| Stroke | Echocardiography: Transthoracic (TTE) or transesophageal (TEE) for detection of intracardiac masses | Patients without clinical cardiac disease |
| Stroke | Treatment for patent foramen ovale | General population |
| Suicide | Suicide risk evaluation | General population |
| Thyroid cancer | Neck Palpation | Adult population |
| Thyroid disorders | Thyroid stimulating hormone test | Perimenopausal women |
| Tuberculosis | INH Prophylaxis | General population aged >35 years |
| Urinary infection | Urine dipstick or culture | Elderly, ambulatory women |
| "D" Recommendations | ||
| Bladder cancer | Urine dipstick or cytology | General population |
| Cardiovascular disease | Vitamin E | Patients with established CVD or risk factors for CVD |
| Carotid disease/Stroke | Neck auscultation or carotid endarterectomy | General population |
| Cervical cancer | Human papillomavirus screening | Women |
| Depression | General Health Questionnaire or Zung Self-rating depression scale | General population |
| Diabetes mellitus | Blood glucose, fasting | Non-pregnant General Population |
| Gonorrhea | Gram stain/culture of cervical or urethral smear | General population |
| Lung cancer | Chest radiography | General population |
| Lung cancer | Vitamin E | General population |
| Oral cancer mortality | Population screening by clinical examination | General population |
| Ovarian cancer | Pelvic exam, transvaginal ultrasound, CA 125 or combination | Pre- and Post-menopausal Women |
| Pancreatic cancer | Abdominal palpation, ultrasound or serologic tumor markers | General population |
| Periodontal disease | Brushing with electric toothbrush | General population |
| Progressive renal disease | Urine dipstick | General population |
| Stroke | Echocardiography: Transthoracic (TTE) or transesophageal (TEE) for detection of intracardiac masses | Patients with pre-existing indications for anticoagulation or contraindications to anticoagulation |
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"E" Recommendations |
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| Breast cancer follow-up | Blood work and diagnostic imaging | Women having been previously diagnosed with breast cancer |
| Lung cancer | Sputum cytology | General population |
| Tuberculosis | Mantoux tuberculin skin test | General population |
| Urinary tract infection (asymptomatic) | Urine dipstick or culture | Elderly, specific subgroups |
| "I" Recommendations | ||
| Cancers (esophageal, stomach, colorectal, urological, prostate) | Vitamin E | General population |
| Cardiovascular disease | Vitamin E | General population and male smokers |
| Falls prevention in long-term care facilities | Structured multidisciplinary programs | High-Risk Elderly |
| Falls prevention in long-term care facilities | Interventions (e.g., physiotherapy or exercise programs) to reduce specific risk factors | Elderly |
| Lung Cancer | Spiral CT scanning | General population |
| Osteoporotic fractures | Screening using bone turnover markers to predict fractures | Postmenopausal women |
| Osteoporotic fractures | Primary prevention of fragility fractures using raloxifene, bisphosphonates, calcitonin, parathyroid hormone, fluoride or combination therapy | Postmenopausal women |
| Osteoporotic fractures | Secondary prevention of fragility fractures using calcium and vitamin D alone, HRT, exercise, calcitonin, parathyroid hormone, fluoride or combination therapy | Postmenopausal women |
| Osteoporotic fractures | Tertiary prevention of fragility fractures using exercise, HRT, calcitonin, fluoride or combination therapy | Postmenopausal women |