Preventive care is crucial for staying healthy, but not all screenings benefit everyone equally, especially as we age. Recent research is challenging long-held assumptions about which medical tests and procedures actually improve health outcomes for older adults, revealing that some widely recommended screenings may carry more risk than benefit for people over 75.

Why Are Doctors Rethinking Colonoscopies for Older Adults?

One of the most striking findings involves colonoscopies, a screening procedure many older adults undergo regularly. A new study of nearly 92,000 Veterans Affairs patients over 75 who had previous colonoscopies found that the benefits of repeat screening were surprisingly minimal. Among those with a previous adenoma, a type of polyp that can become cancerous, just 0.5% died of colon cancer within 10 years, compared with 0.4% of those without one. "A tiny difference," according to researchers.

The risks, however, are real. Nearly 7% of patients over 75 experienced a hospitalization or emergency room visit within a month of having a colonoscopy. For older adults taking blood thinners due to heart conditions, the procedure requires temporarily stopping these medications, which increases the risk of serious complications like bleeding, anesthesia reactions, or perforation of the colon.

"Even if the procedure goes well, you'll either find nothing or you'll find something that's not going to have real impact on your longevity," said Dr. Steven Itzkowitz, a gastroenterologist at the Icahn School of Medicine at Mount Sinai in New York.

Dr. Steven Itzkowitz, Gastroenterologist at Icahn School of Medicine at Mount Sinai

The U.S. Preventive Services Task Force gives colonoscopy screening a lukewarm C rating after age 76, calling the benefit "small". Yet despite this guidance, almost 60% of older patients with limited life expectancies (less than five years) are still advised to undergo another screening.

What Other Medical Routines May Be Unnecessary for Older Adults?

Colonoscopies aren't the only preventive care practice being reconsidered. Researchers have identified several other common medical routines that may not benefit older patients and could even cause harm.

• Actinic Keratosis Removal: These reddened or rough patches on the skin appear in nearly 30% of older Medicare beneficiaries over a five-year period, and doctors typically remove them through freezing, topical creams, or laser therapy. However, for the average patient with no history of skin cancer, there is less than a 1-in-1,000 chance of these lesions progressing to skin cancer. The lesions are far more likely to disappear on their own, and removal can be extremely painful, causing swelling, irritation, and lasting discoloration.
• Levothyroxine for Subclinical Hypothyroidism: This thyroid medication is one of the world's most frequently prescribed drugs, often given for life. However, recent research from Leiden University Medical Center found that in many older adults with subclinical hypothyroidism, hormone levels normalize on their own. The drug had no effect on symptoms and "no apparent benefit" in older patients, yet it requires frequent lab tests, follow-ups, and can interact with other medications.
• Repeat Colonoscopies After Age 75: While initial screening may be appropriate, repeat colonoscopies in older adults with previous normal results offer minimal benefit in preventing colon cancer death, particularly when weighed against the procedural risks.

A quarter of 370 participants over 60 in a Dutch study were able to discontinue levothyroxine while maintaining healthy thyroid function, though most had been on lower doses to begin with. Experts emphasize that patients should not stop taking medications on their own; any changes require gradual tapering with testing and medical monitoring.

How Should Older Adults Approach Preventive Care Decisions?

The shift in thinking doesn't mean older adults should skip preventive care altogether. Rather, it highlights the importance of personalized decision-making based on individual health status, life expectancy, and personal values. The key is having open conversations with healthcare providers about which screenings truly align with your health goals.

For those concerned about cancer risk, early detection through appropriate screenings remains valuable when the benefits clearly outweigh the risks. Regular cancer screenings can help detect abnormal changes before symptoms appear, allowing doctors to begin treatment earlier and improve the chances of successful recovery. Early detection can make treatment simpler, less stressful, and more effective, particularly for breast cancer, colorectal cancer, and cervical cancer.

"The treatment may be more burdensome than the condition itself," said Dr. Allison Billi, a dermatologist at the University of Michigan, regarding unnecessary skin lesion removal.

Dr. Allison Billi, Dermatologist at the University of Michigan

The challenge lies in shifting established medical norms. Many older women continue having mammograms past the point of documented benefit, and older men often undergo prostate cancer screening beyond the recommended age. Efforts to "deprescribe" drugs or reduce unnecessary procedures can meet with opposition from both patients and healthcare professionals.

Rather than following a one-size-fits-all approach, older adults should discuss with their doctors which screenings make sense for their specific situation, considering factors like overall health, life expectancy, and the presence of other medical conditions. The goal of preventive care should be to improve quality of life and longevity, not simply to perform every test available.