A Guide to Annual Physicals After 40

When was the last time you had your cholesterol checked? Or a Pap smear completed? Have you ever had the shingles vaccine or a bone density scan?

Many Americans don’t know the answer to these questions or when they’re even supposed to be asking them.

According to the results of a national questionnaire used by the U.S. Department of Health and Human Services (HHS), only 8.5% of adults 35 and older received all of the priority preventive services recommended for them in 2015, such as those mentioned above. By 2018, that percentage dropped to 6.9%—a figure that likely worsened due to decreased access to health care during the pandemic.

As a result, HHS is focusing on increasing preventive care as part of its Healthy People 2030 campaign. On an individual level, you can take preventative health into your own hands every year.

The first step? Knowing what to expect for your age group. The second step? Understanding what questions to ask.

We spoke with two primary care providers (PCPs) about the health changes and recommendations most people can expect in their 40s and beyond and what they wished people knew to ask about each decade.

“Asking how you can optimize your health should be part of the conversation with your PCP at every visit, at every age,” Malathi Srinivasan, MD, clinical professor of medicine at Stanford University, told Verywell via email. “This question will open a conversation that will help your [healthcare provider] understand your individual health risks and personalize your care.”

If you don’t have a PCP, Danielle Carter, MD, FAAFP, a family physician in Jacksonville, Florida, says it’s never too late to get one. And it’s essential to healthy aging and maintaining your independence over time.

“If you don’t already have an established relationship with a family physician or primary care [provider], don’t delay,” Carter told Verywell via email. “It’s important to take good care of yourself as you age. You’re worth it!”

Health Changes to Expect in Your 40s

If you think you notice some physical changes after turning 40, you’re not alone. Srinivasan explains that habits such as drinking, smoking, recreational drugs, and lack of exercise catch up with us in our 40s, as do decades of sun exposure.

In addition, your 40s can mark the onset of several common chronic conditions.

“At age 40, we begin additional recommended screenings,” Carter said. “During middle age, we are more likely to be diagnosed with ‘silent’ conditions, like high blood pressure, high cholesterol, or diabetes that need to be treated to prevent complications later in life.”

Recommended Screenings

Beyond annual blood tests, several recommended screenings should happen in your 40s, including:

• Colorectal cancer screening every five to 10 years (depending on method) starting at age 45 for people with average risk
• Pap smear and human papillomavirus (HPV) testing (for people with a uterus) every three to five years if results are normal
• Breast cancer screening every one to two years (you have the choice to start in your 40s or 50s)
• A one-time Hepatitis C, human immunodeficiency virus (HIV), and sexually transmitted infection (STI) screening
• Diabetes screening every three years if you are overweight or obese
• Discuss one-time universal chronic hepatitis B virus testing

Recommended Vaccines

Recommended vaccines in your 40s include the following:

• Annual flu vaccination
• Tetanus booster (every 10 years)

Questions to Ask Your PCP

In addition to going over family history, Srinivasan recommends asking your PCP the following important questions after turning 40:

• What is my body mass index (BMI)? A higher BMI puts you at a higher risk for diabetes, hypertension (high blood pressure), heart disease, and stroke.
• Which chronic disease screening(s) do I need this year?
• Have I had a universal screening for chronic infections (HIV, hepatitis C, STIs)?
• Do I need a colon cancer screening?
• Should I start getting mammograms to screen for breast cancer?
• How much sleep do I need?
  
• Should I be screened for sleep apnea? (Sleep apnea is more common after age 40.)

Health Changes to Expect in Your 50s

Bone health, weight gain, and sexual health are important health factors to consider as we turn 50, Srinivasan says.

In this decade of life, bone starts to break down in the absence of weight-bearing exercises, calcium, and vitamin D. At the same time, metabolism tends to slow, and menopause may be linked to decreased libido.

Exercise and proper nutrition will help you optimize your lifestyle, as well as continued monitoring of any chronic diseases and general cardiovascular (heart) health.

Recommended Screenings

While many of the recommended screenings for people in their 50s are the same as for people in their 40s, Carter emphasizes one unique screening that should enter the rotation: Current and former smokers should start getting annual low-dose computed tomography (CT) scans of the chest to look for lung cancer.

In addition to routine blood work and blood pressure screenings, recommended screenings during your 50s include:

• Pap smear and HPV testing (for people with a uterus) every three to five years if results are normal
• Colorectal cancer screening every five to 10 years (depending on method) starting at age 45 for people with average risk
• Breast cancer screening every one to two years (you have the choice to start in your 40s or 50s)
• Annual lung cancer screening (for those with a smoking history of "20 pack years"—a pack of cigarettes per day for 20 years)

Talk to your PCP about the pros and cons of getting a prostate-specific antigen (PSA) test to screen for prostate cancer.

Recommended Vaccines

Recommended vaccines in your 50s include the following:

• A one-time shingles vaccine (a two-shot vaccine called Shingrix prevents up to 91% of shingles cases)
• Annual flu vaccination
• Tetanus booster (every 10 years)

Questions to Ask Your PCP

Srinivasan recommends asking your PCP the following important questions after turning 50:

• Where can I get my shingles vaccine? 
• How can I maintain my sexual health if menopause-related vaginal dryness is making sex painful?
• How is my cardiovascular health?
• Do I need gastric cancer screening?

Health Changes to Expect in Your 60s

According to Srinivasan, many people need to work harder to maintain their physical health in their 60s, especially if they’re experiencing a series of life transitions, like retirement.

Along with a reduction in muscle and bone mass, many people start to notice changes in cognitive functioning and a decline in immune function, putting them at an increased risk of infections.

Recommended Screenings

For women in their 60s, bone density screening is a priority. That’s because, according to Srinivasan, around 22% of women in their 60s have lost enough bone mass to increase their fracture rate.

Men over age 65–75 with a smoking history should be screened for an abdominal aneurysm.

In tandem with routine blood work and blood pressure screenings, people in their 60s should undergo the following:

• Colorectal cancer screening every five to 10 years (depending on method) starting at age 45 for people with average risk
• Pap smear and HPV testing (for people with a uterus) every three to five years if results are normal
• Annual lung cancer screening (for those with a smoking history of 20 pack years—a pack of cigarettes per day for 20 years)
• Breast cancer screening every one to two years (you have the choice to start in your 40s or 50s)
• Bone density scan (for women age 65) every two years
  
• A one-time abdominal aneurysm scan (for men over 65 with a history of heavy smoking)

Talk to your PCP about the pros and cons of getting a prostate-specific antigen (PSA) test to screen for prostate cancer.

“Check with your family [healthcare provider], but based on prior history, you may be eligible to stop getting Pap smears at age 65,” Carter said. “Before discontinuing the screening, you should have two consecutive normal Pap smears.”

Recommended Vaccines

Recommended vaccines in your 60s include the following:

• Pneumococcal (pneumonia) vaccine
• Annual flu vaccination 
• Shingles vaccine (if you haven’t already received it)
  

Questions to Ask Your PCP

Srinivasan recommends asking your PCP the following important questions after turning 60:

• Should I get the new pneumococcal vaccine PCV20 (one-shot series) or the older PCV15 and 23 (two-shot series)?
• Do I need to modify my exercise regimen to maintain my cardiovascular health?
• Do I need to screen for lung cancer?
• Do I need a bone scan?
• Do I need an abdominal ultrasound to screen for a dilated abdominal aorta?

Health Changes to Expect in Your 70s

While she describes your 70s as a vibrant decade, Srinivasan adds it’s especially important to focus on three things to avoid sliding into disability:

• Fall prevention
• Advanced care planning
• Social connection

Recommended Screenings

Depending on family history and risk factors, you may be able to stop a few screenings in your 70s.

“Discuss with your family [healthcare provider] the risks and benefits of discontinuing colon and breast cancer screening at age 75,” Carter said. “Women should continue bone density screening every two years, which is also sometimes recommended for men 75 and older.”

Recommended screenings in your 70s include:

• Colorectal cancer screening every five to 10 years (depending on method) starting at age 45 for people with average risk
• Pap smear and HPV testing (for people with a uterus) every three to five years if results are normal
• Annual lung cancer screening (for those with a smoking history of 20 pack years—a pack of cigarettes per day for 20 years)
• Breast cancer screening every one to two years (you have the choice to start in your 40s or 50s)
• Bone density scan (for women age 65) every two years
• A one-time abdominal aneurysm scan (for men over 65 with a history of heavy smoking)

Talk to your PCP about the pros and cons of getting a prostate-specific antigen (PSA) test to screen for prostate cancer.

Recommended Vaccines

Recommended vaccines for people in their 70s include an annual flu vaccination.

Questions to ask your PCP

Srinivasan recommends asking your PCP the following important questions after turning 70:

• What health changes or complications should I look out for?
• Do you have a copy of my advanced care plan?
• Do I need a fall prevention program?
• Should I take an antidepressant for my mood?
• Should I be screened for problems with brain function?
  

Health Changes to Expect in Your 80s

Srinivasan says that preserving independence and focusing on physical, cognitive, and emotional wellbeing is important for people entering their 80s and beyond. Above all, she recommends preventing social isolation and monitoring for signs of cognitive impairment, also called dementia.

Part of aging tends to mean more medications. Carter adds that managing your prescriptions is of the utmost importance in your 80s.

“I recommend having your medications reviewed at each primary care visit to ensure all medications are still necessary, dosed properly, and not causing any side effects or interactions,” she said.

Recommended Screenings

Since the risk of some cancers, such as cervical cancer, declines as people age, many routine screenings are not recommended in your 80s and beyond. This is decided based on your overall health status.

“Being open about issues like problems with hearing, vision, mobility, balance, and thinking make a world of difference in getting early interventions in place to improve independence, healthspan, and lifespan,” Srinivasan said.

In addition to screening for high blood pressure and diabetes and obtaining routine blood work, recommended screenings for people in their 80s include:

• Lung cancer screening (if you have a history of smoking)
• Bone density scan 

It’s also helpful to evaluate your household for any fall risks.

Recommended Vaccines

Recommended vaccines for people in their 80s include an annual flu vaccination.

Questions to Ask Your PCP

Srinivasan suggests asking your PCP the following important questions after turning 80:

• Are there any medications that I can stop or reduce?
• Do I need someone in my home to help with day-to-day activities?
• Should I get my vision and hearing checked? (Men and women are at high risk for hearing and vision loss in their 80s.)
• How do I know if it’s safe for me to be driving?
• Which cancer screenings do I still need?