For Many Older Adults, It May Be Time to Reconsider Colonoscopy, Actinic Keratosis Treatment, and Levothyroxine

An older patient comes in for a routine visit, and the checklist is familiar: colonoscopy follow-up, a rough scaly patch on the forehead, a thyroid pill that has been on the med list for years. The news here is that all three may deserve a fresh look.

KFF Health News reports that researchers have expanded the list of medical routines that may no longer make sense for some older adults, adding colonoscopy, treatment of actinic keratosis, and levothyroxine use to a growing conversation about when standard care stops being standard benefit. The central issue is not age alone. It is the balance of likely benefit, likely harm, life expectancy, and what the patient actually wants.

For working physicians, this is less about stopping care than about retiring autopilot. Many of these decisions are made in the margins of busy practice, where a medication refill gets renewed, a screening gets scheduled, or a skin lesion gets frozen because that is what has always happened before.

What the new reporting actually found

According to KFF Health News, researchers recently added three common interventions to a list of care that older people may not need in the same way they once did.

The first is colonoscopy. The point is familiar but still uncomfortable in clinic: for some older adults, especially those with limited life expectancy, the downsides of colonoscopy can outweigh the chance of meaningful benefit. Screening takes time to pay off. The burdens are immediate — bowel prep, sedation, procedural complications, and the whole cascade that can follow an incidental finding.

The second is treatment of actinic keratosis. These lesions are common, and many clinicians treat them reflexively because they are seen as precancerous. The reporting suggests that for older patients, especially those who are frail or have limited life expectancy, the value of treating every lesion is less clear. If a lesion is unlikely to become clinically important during the patient's remaining years, treatment can become one more uncomfortable intervention with little practical upside.

The third is levothyroxine use. KFF Health News says researchers have raised questions about whether some older adults still need the drug, particularly when it was started long ago and simply continued. That does not mean hypothyroidism should go untreated. It does mean that an old prescription may merit reassessment, especially when the original indication is uncertain or when treatment offers little symptom benefit and adds to polypharmacy.

Taken together, these examples reflect a broader geriatrics principle: what is appropriate at one stage of life may not remain appropriate later on.

Worth knowing. The issue is not whether these interventions are ever useful in older adults; it is whether they still make sense for the individual patient sitting in front of you.

How this lands in practice

The practical message is straightforward. Reassess the routine before you renew it.

For colonoscopy, that means asking whether the patient is likely to live long enough to benefit from screening or surveillance, and whether the procedural burden is acceptable. A healthy older adult may still be a reasonable candidate. A frail patient with multiple competing illnesses may not be.

For actinic keratosis, the same logic applies. If the lesion is asymptomatic and the patient's overall health is poor, watchful waiting may be more sensible than repeated cryotherapy or topical treatment. That conversation can be harder than the treatment itself. Patients often hear “precancer” and assume action is mandatory.

Levothyroxine may be the trickiest of the three because it is so embedded in routine care. Many older adults take it for years without anyone revisiting why it was started, whether thyroid function still supports treatment, or whether the patient feels any difference. In a population already carrying a heavy medication burden, even one small pill deserves scrutiny.

A reasonable office approach might include:

• reviewing the original indication for levothyroxine before continuing indefinite therapy
• discussing time-to-benefit when considering colonoscopy in older adults
• distinguishing symptomatic or concerning skin lesions from actinic keratoses being treated by habit
• asking patients what burdens they most want to avoid

This is also where shared decision-making becomes real, not rhetorical. Older adults vary widely. Some want every possible preventive step. Others are tired of appointments, procedures, and creams that sting more than they help. The right answer often lives in that conversation.

The asterisks

The KFF Health News piece is a report on researchers expanding a list of low-value or lower-value medical routines for older adults. It is not, at least in the source material provided, a new randomized trial with a single endpoint or a formal guideline update.

That matters. The recommendations described here depend heavily on clinical context. “Older people” is not a clinically uniform category. Chronologic age, frailty, comorbidity, function, prognosis, and patient preference all shape whether an intervention is worthwhile.

There is another limitation built into this kind of work: the evidence base is often stronger for identifying potential harms than for telling clinicians exactly when to stop. Colonoscopy, dermatologic treatment, and thyroid replacement all have legitimate roles. The challenge is deciding when a routine intervention has crossed the line from helpful to habitual.

What to watch next

The next step is likely not a sudden stop to these practices but more pressure to individualize them. Expect this list to feed ongoing discussions in geriatrics and primary care about deprescribing, screening cutoffs, and time-to-benefit.

In the meantime, the useful move is simple. When an older patient is due for a colonoscopy, asks about a scaly lesion, or comes in with levothyroxine on the med list, pause before clicking renew or refer. Those few extra seconds may be the most evidence-based part of the visit.