Ageing well is mostly a small number of things done for a long time

There is a version of health journalism that treats every new finding as a discovery and every intervention as equally weighted. It produces a reader who knows about forty-two things and does none of them.

So it is worth occasionally stepping back and asking what the evidence actually supports at the level of a whole life, in rough order of how much it matters. The list is short. Almost nothing on it is a purchase.

1. Do not smoke

Nothing else on this list comes close. Smoking cessation at any age improves outcomes, and the gains at sixty or seventy are larger than most smokers believe — lung function decline slows, cardiovascular risk falls substantially within a few years, and cancer risk declines steadily.

The evidence for what helps is clear: combination pharmacotherapy plus behavioural support roughly triples success rates over willpower alone.

2. Keep moving, and lift something heavy twice a week

The dose-response curve for physical activity and mortality is steepest at the bottom — the largest benefit comes from moving from nothing to something. Beyond that, the two components with distinct benefits are aerobic activity, which protects cardiovascular and metabolic health, and resistance training, which protects the muscle mass that determines independence.

The realistic target is around 150 minutes a week of moderate activity plus two resistance sessions. The useful target, for someone doing nothing, is a ten-minute walk today.

3. Treat blood pressure, and treat hearing loss

Two of the highest-value medical interventions available across a life, and both routinely deferred.

Hypertension is the leading modifiable risk factor for stroke, contributes to heart failure and kidney disease, and appears in the Lancet Commission's list of modifiable dementia risk factors. It is asymptomatic, which is precisely why it goes untreated.

Hearing loss sits at the top of that same midlife risk list, and the average person waits a decade to act on it.

4. Eat mostly plants, get enough protein, and do not lose muscle

The dietary patterns with the best evidence — Mediterranean, DASH, and their variants — converge on the same structure: vegetables, legumes, wholegrains, nuts, fish, olive oil, limited red and processed meat, limited refined sugar.

The age-specific adjustment is protein. Requirements rise after sixty because of anabolic resistance, and most guidance aimed at the general population is set too low for older adults.

5. Sleep, and treat what stops you sleeping

Not by taking sedatives, which cause more harm than they prevent in this age group, but by treating the causes — sleep apnoea, nocturia, pain, depression, circadian drift — and by using CBT for insomnia where the problem is insomnia.

6. Stay connected, and be needed by somebody

Social isolation is associated with mortality at a magnitude comparable to several established medical risk factors. Purpose is associated with mortality, disability and, in one striking finding, with better cognitive function for a given burden of Alzheimer's pathology.

The practical version is not "socialise more". It is: hold a recurring commitment where somebody notices whether you turn up.

7. Have fewer medicines than you have conditions

Medicine adds drugs efficiently and removes them badly. A structured medication review is among the highest-value hours available to anyone over seventy-five, and it has to be asked for.

8. Take the vaccines

Influenza, shingles, pneumococcus, COVID, RSV, tetanus. Cheap, effective, and — shingles in particular — chronically under-taken.

9. Fall-proof the person, not just the house

Strength and balance training reduces falls by around a quarter. Removing rugs helps some people. Reviewing the medication list, checking the vision and treating postural hypotension help more.

10. Decide things in advance

Where you want to live. Who decides for you. What you would and would not want. Whether the house works with a walking frame. These decisions get made anyway; the only question is whether you make them or whether they get made for you in a hospital corridor.

What is not on the list

Anything that costs a subscription. Anything discovered last month. Anything that requires believing a mechanism nobody has demonstrated in humans.

The interventions that work are boring, cheap, well established, and mostly things you already know. The difficulty was never information. It is that doing eight ordinary things for thirty years is harder than buying a bottle — and it is, by a very wide margin, what the evidence actually supports.