Laboratory Testing in Older Adults: Indications, Benefits, and Harms

Laboratory testing trends have changed from a tendency to ordering numerous laboratory tests in the past to the current approach in requesting tests selectively and on an individualized basis. The number of tests ordered, the type of tests requested, the costs involved, and the value provided ultimately define in large measure the quality and cost of care provided. Multiple and repetitive laboratory testing is not proven to be of value and escalates costs of healthcare. Older adults manifest multi-morbidity and accordingly are subject to cumbersome and needless testing. Selective testing has value in the screening for disease, in evaluating the stage of disease, and in determining management strategies or their efficacy. Test results may yield a diagnosis, but there may be no specific treatment available for the disorder. The asymptomatic patient with abnormal test results is always an enigma. Test results may provide satisfaction in yielding a diagnosis, but there may be no specific treatment available for the disorder. Age by itself is not associated with significant alterations in laboratory test results. Marked deviations in test results usually indicate the presence of underlying disease or a response to therapy. Testing trends prior to a surgical procedure must be tailored to history, physical examination, comorbidity, and the procedure. Results of laboratory testing may be influenced by several factors, including use of medications, both prescribed and over the counter. Routine repeat testing of common tests does not offer advantage over a single run. Discussing the indications and value of testing with the patient is the first step; decision for testing must relate to benefits outweighing any disadvantages.