Blood Tests for Seniors: Essential Guide for Over 60s
As we age, regular blood tests become increasingly important for catching problems early, monitoring medications, and maintaining quality of life. This guide covers what every Australian over 60 should know.
Why Blood Testing Changes After 60
Blood testing takes on new importance in older adults for several interconnected reasons. First, the prevalence of chronic diseases rises steeply — diabetes, kidney disease, thyroid dysfunction, anaemia, and cardiovascular disease all become significantly more common. Second, polypharmacy (taking 5 or more medications) affects approximately 40% of Australians over 65, and many of these medications require regular blood test monitoring. Third, some reference ranges change with age — what is normal at 30 may not be normal at 75.
The RACGP recommends a comprehensive annual health assessment for all patients with chronic conditions. For those aged 75 and over, Medicare funds a specific 75+ Health Assessment (MBS item 701/703/705/707) that includes a thorough review of medical, social, and functional health. Blood tests are a central component.
Importantly, the goal of testing in older adults shifts from purely disease detection to optimising quality of life. Detecting and correcting vitamin D deficiency reduces falls. Catching B12 deficiency early prevents irreversible nerve damage. Monitoring kidney function ensures medications are dosed safely.
8 Essential Annual Blood Tests for Over 60s
Full Blood Count (FBC)
Why it matters after 60: Anaemia is extremely common in older adults — affecting approximately 20% of people over 85. It causes fatigue, falls, cognitive decline, and worsens heart failure. In seniors, anaemia is often caused by chronic kidney disease, chronic inflammation, iron deficiency from occult GI bleeding, or B12/folate deficiency. The FBC also detects elevated WBC (infection, leukaemia) and low platelets (increased bleeding risk, especially in patients on blood thinners).
Age-specific considerations: Haemoglobin naturally declines slightly with age, particularly in men. However, anaemia should never be dismissed as "just ageing." The WHO defines anaemia the same way regardless of age: Hb below 130 g/L (men) or 120 g/L (women). Even mild anaemia (Hb 110–130 in men) is associated with increased mortality, hospitalisation, and falls risk in older adults.
How often: Annually as part of routine health check. More frequently if on anticoagulants, chemotherapy, or with chronic disease.
Kidney Function (eGFR, Creatinine, Urea)
Why it matters after 60: Kidney function is one of the most important tests in older adults because it affects medication dosing, cardiovascular risk, and overall prognosis. Chronic kidney disease (CKD) affects over 1.7 million Australians and is most prevalent in people over 60. Many common medications — metformin, ACE inhibitors, NSAIDs, antibiotics — require dose adjustment or avoidance based on eGFR. Potassium must be monitored because both high and low levels can trigger fatal cardiac arrhythmias.
Age-specific considerations: eGFR naturally declines with age — approximately 1 mL/min/year after age 40. An eGFR of 60–89 in a 75-year-old may be physiologically normal, not CKD. However, eGFR below 60 is always significant and warrants monitoring. The CKD-EPI formula (used since 2021) is more accurate than the older MDRD formula in the elderly. Cystatin C-based eGFR is more accurate in sarcopenic older adults.
How often: Annually for all over 60. Every 3–6 months if eGFR below 60 or on nephrotoxic medications.
Liver Function Tests (LFTs)
Why it matters after 60: Liver function tests in seniors serve multiple purposes: detecting drug-induced liver injury (statins, paracetamol, methotrexate, antifungals), screening for non-alcoholic fatty liver disease (NAFLD, present in approximately 30% of older Australians), monitoring alcohol-related liver damage, and assessing nutritional status (albumin). Low albumin is a powerful predictor of poor outcomes in hospitalised elderly patients — it reflects both liver function and nutritional adequacy.
Age-specific considerations: ALP (alkaline phosphatase) naturally increases with age due to bone turnover and should be interpreted cautiously. An isolated ALP elevation in an older person may be from Paget’s disease of bone rather than liver pathology — GGT helps differentiate (GGT is liver-specific, ALP is not). Albumin levels decline slightly with age but below 35 g/L always warrants investigation.
How often: Annually. Every 3–6 months if on hepatotoxic medications (statins, methotrexate).
Diabetes Screening (HbA1c, Fasting Glucose)
Why it matters after 60: Type 2 diabetes prevalence increases dramatically with age — approximately 15% of Australians over 65 have diabetes, and another 10–15% have pre-diabetes. In older adults, diabetes accelerates cardiovascular disease, kidney decline, cognitive impairment, and peripheral neuropathy (increasing falls risk). HbA1c is the preferred screening test because it does not require fasting. However, HbA1c targets are less strict in the elderly: RACGP guidelines recommend 53–64 mmol/mol (7–8%) for older adults with comorbidities, compared to below 53 mmol/mol (7%) for younger patients.
Age-specific considerations: HbA1c can be falsely low with anaemia (common in elderly) or elevated with kidney disease. Fasting glucose may be normal in early type 2 diabetes when post-meal glucose is already abnormal. Aggressive glucose lowering in the elderly increases hypoglycaemia risk, which causes falls, confusion, and cardiovascular events.
How often: Annually for screening. Every 3–6 months for known diabetics. Part of Medicare heart health check (ages 45–79).
Lipid Panel (Cholesterol)
Why it matters after 60: Cardiovascular disease remains the leading cause of death in Australians over 65. Lipid testing is essential for monitoring existing statin therapy (approximately 30% of Australians over 65 take a statin) and for ongoing cardiovascular risk assessment. While the absolute benefit of starting statins in primary prevention diminishes somewhat after age 75, statins should be continued in those already taking them and started in those with established cardiovascular disease regardless of age.
Age-specific considerations: Total cholesterol naturally declines slightly after age 75 — this does NOT mean cardiovascular risk has decreased. Paradoxically, low total cholesterol (below 4.0 mmol/L) in the very elderly without statins is associated with increased mortality (the "cholesterol paradox"), likely reflecting malnutrition, chronic disease, or frailty. Non-fasting lipid panels are now accepted for screening.
How often: Annually. More frequently during statin dose adjustment.
Thyroid Function (TSH)
Why it matters after 60: Thyroid disease is underdiagnosed in older adults because symptoms overlap almost entirely with normal ageing: fatigue, weight changes, cognitive slowing, depression, constipation, and dry skin. Hypothyroidism affects approximately 10% of women over 60 and 3% of men. Untreated hypothyroidism worsens heart failure, increases cholesterol, and contributes to cognitive decline. Even mildly suppressed TSH (subclinical hyperthyroidism) in people over 65 doubles the risk of atrial fibrillation — a leading cause of stroke.
Age-specific considerations: TSH reference ranges shift slightly upward with age. Some experts suggest an upper normal TSH of 5–6 mU/L in people over 80. Subclinical hypothyroidism (TSH 4–10 with normal T4) in people over 70 often does NOT require treatment unless TSH exceeds 10 or symptoms are significant. The Endocrine Society of Australia recommends a conservative approach in elderly patients.
How often: Every 1–2 years for screening. Every 6–12 months if on thyroid medication.
Vitamin D and Bone Health
Why it matters after 60: Falls and fractures are among the most serious health risks for older Australians — hip fractures have a 20–30% mortality rate within 12 months. Vitamin D deficiency is extremely common in older adults (35–45% of Australians over 60 are deficient) due to reduced skin synthesis, less outdoor activity, and decreased kidney conversion of vitamin D to its active form. Vitamin D below 50 nmol/L is associated with increased falls risk, muscle weakness, bone loss, and immune dysfunction.
Age-specific considerations: The target vitamin D level is 50–75 nmol/L year-round. Older adults typically need 1000–2000 IU daily supplementation (Osteoporosis Australia guidelines). Calcium supplementation remains controversial — dietary calcium is preferred over supplements, which may increase cardiovascular risk. DEXA scan is recommended for all women over 65 and men over 70 (bulk billed under Medicare).
How often: Annually (test at end of winter for trough level). PTH if vitamin D below 50 nmol/L.
Vitamin B12 and Folate
Why it matters after 60: B12 deficiency affects 10–15% of people over 60, primarily due to reduced stomach acid (atrophic gastritis) which impairs B12 absorption. Many seniors also take proton pump inhibitors (omeprazole, pantoprazole) long-term, which further reduces B12 absorption. B12 deficiency in the elderly is insidious and dangerous — it causes macrocytic anaemia, peripheral neuropathy, balance problems and falls, cognitive decline and memory loss, and depression. The neurological damage can become permanent if not treated within 6–12 months.
Age-specific considerations: Serum B12 below 150 pmol/L is deficient. The "grey zone" of 150–250 pmol/L is common in elderly patients and warrants functional testing with homocysteine or methylmalonic acid. Folate testing alongside B12 is important because folate deficiency produces the same anaemia but NOT the neurological damage — treating folate without checking B12 can mask anaemia while neurological damage progresses silently.
How often: Annually for all over 60, especially those on PPIs, metformin, or vegetarian/vegan diets.
Medication Monitoring: Tests Your Medications Require
| Medication | Blood Tests | How Often | What to Watch For |
|---|---|---|---|
| Warfarin | INR | Weekly initially, then every 4–6 weeks | INR target 2.0–3.0. Above 4.0 = high bleeding risk. |
| DOACs (rivaroxaban, apixaban) | eGFR, FBC | Every 6–12 months | eGFR below 30 contraindicates rivaroxaban. Check for anaemia. |
| Statins | LFTs (ALT), CK if muscle symptoms | Baseline, 3 months, then annually | ALT above 3x normal = stop. CK above 5x with symptoms = rhabdomyolysis risk. |
| Metformin | eGFR, B12 (annually) | Every 6–12 months | Reduce dose if eGFR 30–45. Stop if eGFR below 30. B12 deficiency in 10–30% of users. |
| ACE inhibitors / ARBs | eGFR, Potassium | Baseline, 1–2 weeks after starting, then 6–12 monthly | Creatinine rise >30% = stop. Potassium above 5.5 = dose reduction. |
| Lithium | Lithium level, TSH, eGFR, Calcium | Every 3–6 months | Therapeutic 0.4–0.8 mmol/L (elderly). Above 1.0 = toxicity risk. |
| Methotrexate | FBC, LFTs, eGFR | Every 1–3 months | Bone marrow suppression, liver toxicity, kidney impairment. |
| Digoxin | Digoxin level, Potassium, eGFR | Every 6–12 months | Therapeutic 0.5–1.0 ng/mL (elderly). Low potassium increases toxicity. |
Cancer Screening Blood Tests: What You Should Know
Cancer blood tests (“tumour markers”) are frequently requested but widely misunderstood. Most are not recommended for routine screening in healthy people because they have high false-positive rates:
Prostate cancer screening in men
Who: Men 50–70 (or 45+ if family history/Aboriginal)
Highly debated. Australian guidelines recommend informed shared decision-making. PSA can detect early prostate cancer but has a 75% false-positive rate. Overdiagnosis leads to unnecessary biopsies and treatment of slow-growing cancers. RACGP recommends against routine PSA screening but supports it when a patient requests it after a balanced discussion of risks and benefits.
Ovarian cancer marker
Who: Not recommended for routine screening
CA-125 is elevated in only 50% of early ovarian cancers and is elevated by many benign conditions. The UK CTOCS trial (202,000 women) found NO mortality benefit from screening. CA-125 is useful for monitoring KNOWN ovarian cancer, not screening healthy women.
Colorectal cancer monitoring
Who: Only for monitoring known colorectal cancer
Not useful for screening (elevated by smoking, IBD, liver disease). The NHMRC National Bowel Cancer Screening Program (FOBT/FIT test) is the recommended screening tool for all Australians 50–74.
Liver cancer (HCC) screening
Who: Only in high-risk patients (hepatitis B/C, cirrhosis)
Not a population screening test. Used with liver ultrasound every 6 months in patients with known cirrhosis or chronic hepatitis B.
Medicare 75+ Health Assessment
If you are aged 75 or older, you are entitled to a comprehensive annual health assessment fully funded by Medicare (MBS items 701/703/705/707). This is one of the most valuable preventive health services available and is significantly underutilised — only about 25% of eligible Australians receive one each year.
Comprehensive blood panel (FBC, kidney, liver, diabetes, thyroid, lipids, B12, vitamin D)
Medication review (interactions, adherence, side effects)
Falls risk assessment (balance, vision, footwear, home hazards)
Cognitive screening (memory, orientation)
Mood assessment (depression screening)
Functional status (activities of daily living)
Continence assessment
Hearing and vision check
Social isolation screening
Advance care planning discussion
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Reference ranges and guidelines sourced from the Royal College of Pathologists of Australasia (RCPA), Royal Australian College of General Practitioners (RACGP), and Osteoporosis Australia. SmarterBlood provides health information and AI-powered blood test analysis. It is not a substitute for professional medical advice, diagnosis, or treatment.