Blood Tests for Elderly/Older People (part 2)

  • November 13, 2020
Blood Tests for Elderly/Older People (part 2)

Aging is a steady, and continuous process of human life. As we grow older, many bodily functions begin to gradually weaken and can present seniors with various health challenges. According to the World Health Organization (WHO), people 60 years old and above are referred to as older or elderly persons (1). People of this age group are more susceptible to developing diseases and thus, preventive health care (PHC) is highly recommended for them. To put it precisely, prevention is better than cure. 

There are 10 simple blood tests that are suggested for elderly people when they visit their health care practitioner. Other tests may also be recommended by their doctor based on their personal health profile (PHP). So, during one’s regular check-up, if their doctor hasn’t suggested one or more of these blood tests, they should request a lab order that has the following tests.

Disclaimer: The author wants to put a disclaimer that various authors (2,3), agencies, and authorities including The U.S. Preventive Services Task Force (USPSTF), have recommended various screening tests for elderly people. Though there is consensus in many areas, it is not reflected in all the tests. Therefore, it is highly recommended that while discussing preventive health care with your doctor and making decisions about lab testing, it is important to consider one’s specific health situation and risk factors.

This blog is the second part of a two-part series. The first part talked about the 5 blood tests recommended for elderly people, this post discusses the remaining 5 tests.

Liver (Hepatic) Function Tests

Aging is related to gradual alteration of hepatic function and structure that ultimately increases the risks for various liver diseases (4). The doctor may recommend the liver (hepatic) function tests (LFT’s) to check how well the liver is working. It is a group of tests that measures the blood levels of total protein, albumin, bilirubin, and liver enzymes. 

The Liver function tests may include:

  • Albumin
  • Albumin/Globulin Ratio
  • Alkaline Phosphatase (ALP)
  • Alanine transaminase (ALT) 
  • AST
  • Aspartate Aminotransferase (AST) 
  • Bilirubin, Direct
  • Bilirubin, Indirect
  • Bilirubin, Total
  • Globulin
  • Protein, Total

How regularly should one get this test?

It may be used periodically to detect the liver function but based on age and other factors, a doctor must be consulted to confirm how often one should get tested. The doctor may order a liver function panel if there are symptoms of liver disease or damage.

Why is a Liver blood test required?

The Liver function tests (LFT) may include Protein tests including Albumin, Total Protein, Albumin/Globulin Ratio to measure the number of proteins in the blood as they are imperative building blocks of all cells and tissues and are crucial for the overall growth and development of the body. ALP (alkaline phosphatase), ALT (alanine transaminase), and AST (aspartate aminotransferase) are different enzymes made by the liver. Bilirubin is a waste product produced by the normal breakdown of red blood cells. This is used to evaluate a person’s liver function or to screen for or monitor liver disorders. Abnormal levels may mean that liver disease or damage is present. The LFT also helps doctors see how well an organ (such as the liver or kidneys) is working.

Renal Function Tests 

Kidney disease can occur and develop at any stage of life, but people over the age of 60 are more likely than not to develop kidney disease. Kidneys age as a person gets older. According to studies of the Third National Health and Nutrition Examination Survey, there is a high prevalence of chronic kidney disease in elderly people in the USA. It is estimated to be about 39.4% in the elderly, aged 60+ years, as compared to 11% in the adult population. 

The Renal Function Tests are a group of tests that may be ordered to evaluate how well the kidney (renal) is functioning. The tests include measurement of various substances, including several minerals, electrolytes, proteins, and glucose (sugar), to determine the current health of the kidneys.

The Renal Panel may include testing of:

  • Albumin
  • Bun/Creatinine Ratio
  • Calcium
  • Carbon Dioxide
  • Chloride
  • Creatinine
  • Egfr African American
  • Egfr Non-Afr. American
  • Glucose
  • Phosphate (As Phosphorus)
  • Potassium
  • Sodium
  • Urea Nitrogen (Bun)

How regularly should one get this test?

Normally, renal function blood tests should be run periodically. However, if one has diabetes, it is recommended to get it checked every year. Moreover, if one has high blood pressure, heart disease, or a family history of kidney failure, one should talk with his/her health care provider about the testing frequency. 

Why are Renal Function Tests required?

The Renal Function blood tests include testing for Albumin, a protein found in the blood. If the kidneys are healthy and working properly, there should be very little protein in the urine.  Urea nitrogen is a by-product of the breakdown of food proteins. The increase in its levels is an indicator of unhealthy kidneys BUN-to-Creatinine Ratio (calculated)– is usually between 10:1 and 20:1. An increase in its value may be due to a disorder that causes a decrease in the flow of blood to the kidneys. Similarly, measuring urine calcium can help govern whether the kidneys are excreting the proper amount of calcium. Measuring carbon dioxide levels can be used to help diagnose kidney disease. 

Chloride is an important electrolyte and its increased levels in the blood indicate kidney diseases such as tubular acidosis, the condition when the kidneys do not remove enough acid. High levels of Creatinine in the blood (a waste product that comes from normal wear and tear on the body’s muscles) can help diagnose kidney disease at earlier stages. Estimated Glomerular Filtration Rate (calculated) measures how well the kidneys are removing waste and excess fluid from the blood. Glucose is a type of sugar the body uses for energy. Calcium is an important mineral and is required for the proper functioning of nerves, muscles, and heart

Benign functioning kidneys can remove extra phosphorus from the blood. High phosphorus levels are an indication of chronic kidney disease.

Potassium is an electrolyte that helps in many bodily functions like water balance, digestion, and nerve impulses. Kidney disease can cause both high and low potassium levels. Sodium is another major electrolyte in the body. High sodium levels could indicate kidney disease. 

In a nutshell, the sooner one discovers an issue with their kidneys, the sooner they may get the required treatment to help protect kidneys.

Prostate Cancer Screening

After skin cancer, prostate cancer is the second most frequently diagnosed cancer in men in the USA. According to the American Cancer Society, 1 in 9 men will develop it during their lifetime, with most cases diagnosed in men 65 years of age or older and very rare in men under 40.

Prostate-Specific Antigen (PSA) is a substance produced by cancerous (malignant) and noncancerous (benign) prostate tissue. A trivial quantity of PSA normally enters the bloodstream. The prostate cancer cells in the body typically make more PSA than do benign cells, thus causing PSA levels to rise in the bloodstream. The Prostate-Specific Antigen Blood Test is used to screen men for prostate cancer. It helps determine if there is a need for biopsy and monitors the effectiveness of treatment and can detect recurrence of prostate cancer.

How regularly should one get this test?

According to the U.S. Preventive Services Task Force (USPSTF), men between 55 and 69 should discuss the potential benefits and harms of PSA screening with their health care practitioner before deciding about the screening. Those who are 70 and older should not have routine PSA screenings for prostate cancer.

Why is Prostate cancer screening required?

Prostate cancer screening is done to look for prostate cancer before one has any severe signs or symptoms. If detected earlier the chances of successful treatment of the cancer increase. 

Vitamin B12 Levels

Maintaining adequate nutrients is vital to elderly people’s health. Even after encouraging the older adults to eat healthy and take a multivitamin, many seniors may still develop a grave deficiency with one specific vitamin, and that is Vitamin B12. This is because older people may have a low intake of Vitamin B12 and this can lead to various problems like fatigue, memory problems, and difficulty walking.

The Vitamin B12 (Cobalamin) blood test is usually requested together with the folic acid test. Since the body needs B12 to produce blood cells and the maintenance of a healthy nervous system, this test is necessary to assess nerve function and overall health condition. This test may also be done in people who show signs and symptoms of B12 deficiency which include macrocytic anemia, glossitis, weakness, loss of proprioception, hyperreflexia, loss of physical coordination (ataxia), and behavioral changes. 

How regularly should one get this test?

Older people need this test as part of a routine check-up. The doctor may also recommend checking Vitamin B12 levels if seniors are concerned about memory, brain function, neuropathy, walking, or anemia. 

Why is maintaining adequate Vitamin B12 levels important?

Vitamin B-12 is an important B vitamin and is needed for nerve tissue health, brain function, and the production of red blood cells. Vitamin B-12 deficiency in the body increases the risk of permanent nerve and brain damage. Some people with inadequate Vitamin B-12 also have a higher risk of developing psychosis (a serious mental disorder), mania (a type of Bipolar disorder), and dementia (a mental condition related to loss of memory, language, problem-solving, and other thinking abilities).

Prothrombin Time (PT) and International Normalized Ratio (INR)

Prothrombin is a protein secreted by the liver that helps the blood clot properly. The Prothrombin Blood Test monitors how long it takes blood to clot. The test is used to check for bleeding disorders. Additionally, the test could be utilized to monitor the effectiveness of blood-thinning medications (like Warfarin) used in preventing blood clots. The most common reason older people take warfarin medicine is to prevent strokes linked to atrial fibrillation (quivering or irregular heartbeat). The test is also called Prothrombin Time (PT) with an INR blood test and includes INR (international normalized ratio). The INR is a way of standardizing the results of PT tests, regardless of the testing method used by the labs, and thus may help your doctor in understanding the results more easily.

How regularly should one get this test?

Older people taking the blood-thinner Warfarin are recommended to regularly take the Prothrombin Blood Test. Additionally, one should consult their doctor to confirm the testing frequency.

Why Prothrombin time (PT) blood test is required?

Prothrombin time (PT) blood test measures how long it takes blood to clot. An abnormal prothrombin time may indicate bleeding or clotting disorders. An abnormal/unusual prothrombin time is often caused by liver disease or injury or by treatment with blood thinners.

Written by Dr. Shikha Sharma, Reviewed by Dr. Harshi Dhingra