What to ask at every health check after sixty-five

Start with the thing almost nobody tells you: the Medicare Annual Wellness Visit isn't a physical. It's a paperwork appointment. They'll take your height, weight and blood pressure, run through a risk questionnaire, glance at your medication list, ask a few memory questions and build you a screening schedule. No hands on your abdomen. No listening to your lungs for more than a few seconds. If you walked out of one of those thinking you'd just been checked over, you weren't.

That's not a scandal. It's just how the benefit is written, and it's free once every twelve months, which is more than you can say for most things. But you have to know what it's so you can book the other appointment. The one where somebody actually examines you.

So book both. And walk into each with questions, because the quality of what you get out of a fifteen-minute slot depends almost entirely on what you bring into it.

Before any appointment, own your own list

Write down every pill, patch, inhaler, eye drop and supplement you take. Dose and how often. Include the fish oil and the turmeric capsules your daughter-in-law swears by.

Then count the prescribers. A man at seventy is often on eight or nine medications written by four different people, and the cardiologist doesn't know what the urologist did last spring. Nobody owns the whole list except you.

Bring it printed. Hand it over at the start, not when the doctor's already got his hand on the doorknob.

Ask: "Which of these could I stop?" Then wait. The word for this is deprescribing, and it's a real and growing part of geriatric practice, but it almost never happens unless someone raises it. Ask specifically about anything sedating, anything for sleep, anything anticholinergic, and any acid reducer you started years ago for a problem you no longer have.

Ask: "What's my kidney function, and does it change the dose of anything I'm on?" Kidney function drifts down with age quietly. Plenty of common drugs get cleared by the kidneys, and a dose that was right at fifty-five isn't automatically right at seventy-eight.

The numbers appointment

Blood pressure, cholesterol panel, A1c, kidney function, sometimes thyroid. This is the bread and butter, and the useful move is refusing to accept "everything looked fine."

Ask for the actual numbers. Not a thumbs-up. Get them on paper or pull them off the portal and keep a running file. A single reading tells you almost nothing. Three readings over four years tells you the direction, and direction is the whole game.

Ask: "What's the target for someone my age, and is it different from the standard target?" Blood pressure goals for a fit seventy-year-old and a frail eighty-eight-year-old with dizzy spells aren't the same, and neither are A1c goals. Aggressive targets can cause falls and low blood sugar episodes that do more damage than the number they fixed.

Ask: "If this doesn't move by the next visit, what's the plan?" Makes it a plan instead of a ritual.

Have your blood pressure checked at home too, with a cuff that goes on your upper arm, and bring the log. Wrist cuffs are convenient and less reliable. Take a reading in the morning before coffee and one in the evening, sitting, feet flat, after five minutes of not talking.

Cancer screening, and when to stop

Colon cancer screening runs through seventy-five under current guidelines, and from seventy-six to eighty-five it becomes an individual decision based on your health and whether you've been screened before. Ask where you land. If colonoscopy isn't appealing, ask about stool-based testing, which is done at home and repeats more often.

Prostate is the one to have a real conversation about. The task force recommendation is against routine PSA screening in men seventy and older, and for men in their late fifties and sixties it's framed as a shared decision. That doesn't mean don't test. It means ask two questions: "What would we do with an abnormal result?" and "Given my age and health, would treatment help me more than it hurt me?" A man with a strong family history or African ancestry has a different risk picture, and that's worth saying out loud.

Skin. Get looked at, especially if you spent thirty years roofing, farming, fishing or on a flight line. Back of the ears, scalp, the tops of your forearms, the backs of your hands. Ask about anything that bleeds, scabs, heals, then comes back in the same spot.

If you ever smoked, ask two things. First, whether you qualify for annual low-dose CT lung screening. Second, about a one-time ultrasound for abdominal aortic aneurysm, which is recommended for men sixty-five to seventy-five who've ever smoked. It takes about ten minutes, it's painless, and it's the sort of thing you only find out you needed the hard way.

Bones, balance and the stuff that ends independence

Men get osteoporosis. Formal screening recommendations for bone density are aimed at women, which means a lot of men never get scanned until they break a hip, and a broken hip at eighty is a life-changing event in the wrong direction.

Ask: "Do I have risk factors that justify a DEXA scan?" Long-term steroid use, low body weight, a parent who broke a hip, heavy drinking, a fracture from a fall that shouldn't have caused one. Any of those and you should be asking harder.

Ask: "How's my vitamin D, and am I getting enough calcium from food?"

Then the one people skip. Say out loud whether you've had a fall or a near-fall in the last year, including the ones you didn't tell your wife about. There's a whole workup that follows from that answer: medication review, vision, blood pressure when you stand up, gait and balance testing, home hazards. None of it happens if you say "no, I'm fine."

Ears, eyes, teeth

Vision every one to two years with dilation, including a check for glaucoma and macular degeneration. Glaucoma takes peripheral vision first and you won't notice until a lot of it's gone.

Hearing gets its own appointment, not a nod during a physical. Ask for an audiogram, ask for the chart, ask what the numbers mean in the speech frequencies.

Dental twice a year. Ask your dentist to check for dry mouth caused by your medications, because that quietly wrecks teeth.

Vaccines worth asking about by name

Don't wait to be offered. Ask about shingles, which is a two-dose series and genuinely unpleasant to skip. Pneumococcal. The high-dose or adjuvanted flu shot for sixty-five and up. RSV, which is now recommended for adults seventy-five and older and for younger adults with certain risk conditions. Tdap, which needs a booster every ten years and which matters if there's a newborn grandchild in the house. Ask your doctor about COVID vaccination based on your own health picture.

The questions to end every visit with

Three of them, every time, no exceptions.

"What did we find today that's different from last year?"

"What am I supposed to do before I see you again?"

"What symptom should make me call you instead of waiting for the next appointment?"

Write the answers down in the room. Not in the parking lot, not later. And if the answer to the first one is that nothing changed, that's not a wasted visit. That's a year you held the line, which at seventy-three is an achievement with a number attached to it.