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Health Maintenance: Ages 40–64 Years


Important Considerations (Physiologic Changes)

This age group is notable for transitions from reproductive function to maturity, from rhythmic menstrual function to menopause, and from robust health to the emergence of age-related changes.

Leading Causes of Death

  • Breast, lung, colorectal, and ovarian cancer

  • Coronary artery disease

  • Accidents/unintentional injury

  • Diabetes mellitus and its complications

  • Cerebrovascular disease

  • Obstructive pulmonary disease

Leading Causes of Morbidity

  • Nose, throat, and upper respiratory tract conditions

  • Osteoporosis

  • Arthritis

  • Hypertension

  • Depression

  • Orthopedic deformities, including back and upper and lower extremities

  • Obesity

  • Heart disease

  • Hearing and vision impairments

Screening

History

  • Reason for visit

  • Health status: Medical, surgical, family

  • Dietary/nutritional assessment

  • Physical activity

  • Tobacco, vaping, alcohol, and other drugs (including complementary and alternative medicines)

  • Abuse/neglect

  • Sexual practices/contraception

  • Urinary and fecal incontinence (These issues become more common with childbearing and age, but patients seldom volunteer these complaints.)

Physical

  • Height

  • Weight (body mass index [BMI])

  • Blood pressure

  • Oral cavity

  • Neck: adenopathy, thyroid palpation

  • Breasts

  • Abdomen

  • Pelvic and rectovaginal examination

  • Skin screening

Laboratory

  • Periodic

    • Primary human papillomavirus (HPV) testing every 5 years from ages 30–50 years, regardless of triaging strategy. Studies show that this results in the largest reductions in cervical cancer incidence and mortality rates, with >50% reduction in cervical cancer incidence and >55% reduction in cervical cancer mortality. Cervical cytology alone every 3 years, or cotesting with a combination of cytology and high-risk HPV testing every 5 years is also acceptable for those at low risk between the ages of 30 and 65 years. Cholesterol, high-density lipoprotein cholesterol (every 5 years, starting at the age of 45 years)

      Figure 17.1, Leading causes of death and morbidity in women aged 40–64 years

    • Fecal DNA testing (A single stool sample collected at the time of digital rectal examination is not sufficient to adequately screen for colon cancer.)

    • Sigmoidoscopy (every 3–5 years after the age of 45 years; double-contrast barium enema study may be substituted, or a complete colonoscopy may be performed every 10 years)

  • As indicated by risk factors

    • Bacteriuria testing

    • Colonoscopy

    • Fasting glucose test

    • Hemoglobin

    • Human immunodeficiency virus (HIV) testing

    • Lipid profile

    • Mammography

    • Sexually transmitted disease testing

    • Thyroid-stimulating hormone test

    • Tuberculosis skin test

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