Medical Screenings for Older Adults: Why Less May Be Better for Patients

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The Shifting Calculus of Colonoscopy Screenings After 75

For many clinicians, the decision to perform a routine colonoscopy on an octogenarian has moved from a standard clinical protocol to a complex exercise in risk assessment. Steven Itzkowitz, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York, recently described a case involving an 85-year-old patient in reasonably good health who was due for a repeat screening. While the procedure is a standard tool for reducing colon cancer mortality, the clinical reality for older adults involves a distinct set of hazards. For patients on blood thinners—often prescribed to manage cardiac stents—the requirement to temporarily discontinue medication to facilitate the procedure introduces significant cardiovascular risk. Itzkowitz noted that five years ago, he would have likely scheduled the screening without even thinking about it. Today, the clinical perspective has evolved.

Steven Itzkowitz, gastroenterologist at the Icahn School of Medicine at Mount Sinai

Recent research indicates that the mortality benefits of repeat colonoscopies diminish significantly after age 75. When the potential for perforation, bleeding, or adverse reactions to anesthesia is weighed against the slim statistical benefit of detecting late-life cancer, many practitioners are opting for a more conservative approach.

Addressing Actinic Keratoses: When Treatment Becomes a Burden

Dermatological care for older patients frequently centers on actinic keratoses—the rough, reddened patches resulting from cumulative sun exposure. These lesions appear commonly on the face, scalp, forearms, and hands. According to data from traditional Medicare beneficiaries, nearly 30% of older adults are diagnosed with these lesions over a five-year period. Historically, the immediate removal of these patches via cryosurgery, topical creams, or laser therapy has been the standard of care, driven by the concern that they could progress to skin cancer. However, current dermatological analysis suggests that this aggressive approach may be unnecessary for many. Allison Billi, a dermatologist at the University of Michigan, points out that for the average patient without a history of skin cancer, the risk of progression is statistically minimal.

“For the average patient with no history of skin cancer, there is less than a 1-in-1,000 chance of it progressing to skin cancer.”

Allison Billi, dermatologist at the University of Michigan

Billi emphasizes that these lesions are more likely to resolve spontaneously than to become malignant. Furthermore, the procedures used to remove them are not without consequence. The intervention itself can cause lasting discoloration, irritation, and significant discomfort.

“The treatment may be more burdensome than the condition itself. The vast majority of the time, they’re removed. Removal is actually extremely painful, both during and after. This is a chronic condition.”

Allison Billi, dermatologist at the University of Michigan

Re-evaluating Chronic Medication and Screening Utility

Beyond procedures, the medical community is scrutinizing long-term medication use, specifically involving thyroid treatments like levothyroxine, which many older patients may no longer require. The broader trend reflects a growing recognition that “standard of care” guidelines developed for younger or middle-aged populations do not always map effectively onto the physiological realities of the aging population. The medical consensus is shifting toward a model of “deprescribing” and selective screening. This approach prioritizes patient quality of life and the avoidance of iatrogenic harm—harm caused by the medical system itself. For patients and families, this means the conversation with a primary care provider is becoming increasingly vital. As these clinical shifts continue to develop, the focus remains on individualizing care rather than following rigid procedural calendars. Patients are encouraged to discuss their specific health history and the necessity of ongoing screenings with their healthcare providers to determine which interventions truly serve their long-term health goals.