In Your Fifties

All the changes add up, and the list of medical tests you need is longer.

By: Mary Clare Glover

Celebrating a 50th birthday is a milestone for many reasons, health included. Most doctors say fiftysomethings should have a physical every year. “One of the biggest advantages to our health-care system,” says Centreville internist Elizabeth Anderson, “is that we can have continuity of care with a single provider.”

Annual visits let doctors get to know their patients when they’re healthy, which can help them spot problems as they arise. Regular testing can detect diseases before they change a patient’s quality and quantity of life.

The list of recommended medical screenings and tests begins to grow when you turn 50. That’s the age at which the American Cancer Society advises that colorectal-cancer screenings begin for people of average risk.

“Although there is some controversy about mammograms when you are in your forties,” says DC internist April Barbour, “50 is when they should absolutely become an annual event.”

Women in their fifties should also have an annual clinical breast exam and perform monthly self exams at home. “A lot of people think if they’re getting a mammogram, that’s enough,” says Anderson. “It’s really the trifecta that has improved our ability to detect breast cancer early.”

Women should continue to get an annual Pap smear, which includes a check for cervical cancer. The American Cancer Society’s guidelines say women who have had three normal Pap tests in a row can get screened every two to three years.

Fifty is the age when men should talk with their doctors about prostate-cancer screening. Many physicians recommend an annual PSA blood test and digital rectal exam.

In addition to doing age-appropriate cancer screenings, Chevy Chase internist Sharon Scanlon orders a blood count, chemistry panel, lipid panel, and urinalysis during an annual physical. These help discover abnormalities such as anemia and kidney problems. Scanlon recommends a test every two to three years to check for problems with thyroid-gland function, which is common among women.

Patients should also ask if their immunizations are up to date—tetanus shots should be readministered every ten years. And according to the Centers for Disease Control and Prevention, the flu vaccine should become a regular part of your medical routine at age 50.

Pounds can creep onto the middle-age frame, making diet and exercise more important. Blood pressure and cholesterol levels also can increase. “As people get older, they begin to lose muscle mass,” says Barbour. “It’s crucial to stay active.” She recommends light weights and flexibility exercises to help prevent falls and curb the muscle loss.

A lot of doctors recommend getting an electrocardiogram (EKG) by age 50 to screen for irregular heart patterns. Then if a patient comes in with chest pain, that baseline test can be used for comparison.

By age 50, most women have begun to experience menopause and might want to talk to their doctors about getting a bone-density scan to check for signs of osteoporosis. Fairfax internist Robin B. Merlino recommends 1,200 to 1,500 milligrams of calcium and at least 1,000 units of vitamin D daily for her fiftysomething women patients.

Anderson is seeing more patients with vitamin D deficiencies, including men. “It really is an epidemic,” she says. “We’re living our lives in a different way than we used to. We are under fluorescent bulbs all day; we don’t get our daily 15 to 20 minutes of unopposed sun exposure.” Anderson tests vitamin D levels in all her fifties patients; if there’s a deficiency, she recommends a bone-density test.

Menopausal women often have questions about hormone-replacement therapy, a controversial treatment. Says Scanlon: “We mainly use it now only to treat severe symptoms of menopause,” which include hot flashes and difficulty sleeping. “We use the lowest possible dose for the shortest amount of time.”

Fiftysomethings at high risk for skin cancer—a family history of the disease, fair skin, tanning-bed exposure, a history of childhood sunburns, or a lot of moles—should have their skin checked regularly by a dermatologist. People in their fifties also should visit an ophthalmologist or optometrist every two to three years to screen for glaucoma.

Despite all the physiological changes taking place in middle age, Anderson says the most common new problem she sees among patients in their fifties is depression. The combination of physical and emotional changes—kids leaving home, aging parents needing support—can be hard to juggle.

With so much to look for in fiftysomething patients, doctors stress the importance of taking time to discuss test results, lifestyle, and changes in mood.

“You really have to tailor each visit to the patient,” says Merlino, who spends 20 to 30 minutes during a physical examination talking with the patient and answering questions. “A lot of it is common sense—exercise, diet, stress reduction—but it’s only going to happen if you have these discussions.”

This article first appeared in the October 2009 issue of The Washingtonian. For more articles from that issue, click here.