Brain & Memory
The supplement industry has produced a great deal of confident advertising about brain health and remarkably little convincing data. The interventions with real evidence behind them are duller, cheaper and harder.
Heart & Metabolic
Guidelines have shifted twice in a decade, and the right number for an older adult depends on more than age. What matters is frailty, standing blood pressure and how many other drugs are in the box.
Preventive Care
Prescriptions accumulate over decades and are almost never subtracted. By the mid-seventies, the drugs themselves have become one of the commoner causes of hospital admission.
Living Well
The claim that isolation is as harmful as smoking gets quoted constantly and is more slippery than it sounds. The underlying finding is real, and the useful part is what distinguishes loneliness from being alone.
Preventive Care
Screening has an intuitive logic — find it early, treat it early — that holds for some conditions and quietly fails for others. Age changes the arithmetic in both directions.
Brain & Memory
Waking at four in the morning is not necessarily insomnia, and treating it as though it were is how a lot of older people end up on drugs that make them fall over.
Preventive Care
A T-score of −2.4 sounds alarming and a fracture risk of 8 per cent sounds reassuring, and they can describe the same person. Here is how to read the numbers you are given.
Heart & Metabolic
For secondary prevention the case remains good at any age. For primary prevention in the over-75s, the trials that would answer the question have mostly not been done.
Preventive Care
The average person waits around a decade between noticing hearing difficulty and doing something about it. That delay is not neutral — the auditory system reorganises in the meantime.
Heart & Metabolic
Tight glucose control prevents complications that take fifteen years to develop, and causes hypoglycaemia this week. In an eighty-year-old, that trade runs the wrong way.
Living Well
Sense of purpose predicts mortality, disability and even the rate at which people use preventive healthcare. The effect survives adjustment, and it is more practical than it sounds.
Brain & Memory
Losing your keys is not a symptom. Losing the ability to work out what keys are for is a different matter. The clinical distinction rests on function, not on how often you forget.
Brain & Memory
A third of older patients on a general medical ward develop acute confusion. It is largely preventable, frequently missed, and it is not simply a bad night that resolves on discharge.
Living Well
Age itself is a poor predictor of driving safety. Specific capacities are much better ones — and losing a licence carries real health costs that are rarely weighed against the risk.
Heart & Metabolic
The commonest sustained arrhythmia becomes markedly more common with age, and the decision that follows it is one of the most consistently mishandled in medicine — usually in the direction of undertreatment.
Brain & Memory
It presents as physical complaints, cognitive slowing and loss of interest rather than low mood, which is why it is under-diagnosed, under-treated and frequently mistaken for dementia or simply for ageing.
Preventive Care
Immune function declines with age, which makes vaccination both more necessary and less effective. Several vaccines are specifically formulated to compensate, and most people are not offered them by name.
Heart & Metabolic
Total cholesterol is close to useless on its own, HDL is not simply the good one, and there is a measurement that outperforms all of them which most laboratories still do not report by default.
Heart & Metabolic
Breathlessness on the stairs, swollen ankles and needing an extra pillow are the three commonest presentations, and all three are routinely attributed to age. Half of cases involve a heart that pumps normally.
Brain & Memory
A transient ischaemic attack resolves within an hour and carries a stroke risk of several per cent within the following two days. It is the one neurological symptom you should never wait out.
Brain & Memory
Loss of smell, acting out dreams and stubborn constipation can precede the movement symptoms by a decade. That prodrome is now one of the most active areas in neurology.
Preventive Care
Most new marks that appear on older skin are entirely benign, and a few are not. The distinguishing features are learnable, and the commonest skin cancer rarely looks like what people expect.
Preventive Care
One-year mortality after a hip fracture is comparable to several common cancers. Most of what determines the outcome is decided in the first 48 hours and in the months of rehabilitation afterwards.
Preventive Care
It affects a large minority of older women and a substantial number of men, it drives falls, isolation and care home admission, and the average patient waits years before raising it.
Preventive Care
One is reversible with a twenty-minute operation, one is treatable if caught early, and one steals peripheral vision so gradually that most people do not notice until a third of it has gone.
Living Well
Fraud aimed at older people is designed around urgency, authority and isolation rather than gullibility. Knowing the structure of the approach is more protective than knowing the individual stories.
Heart & Metabolic
Cramping calf pain that starts after a predictable distance and stops within minutes of resting is claudication, and it signals atherosclerosis affecting more than the legs.
Heart & Metabolic
Hypothyroidism presents as fatigue and slowing that is attributed to ageing. Hyperthyroidism in older adults can present with none of the classic features at all — just weight loss and atrial fibrillation.
Living Well
Persistent pain affects around half of older adults living at home and is both under-treated and badly treated. The shift away from opioids has been right in principle and patchy in what replaced them.
Brain & Memory
The classic patient is imagined as an overweight middle-aged man who snores. A substantial share of undiagnosed cases are thin older women whose only complaint is fatigue and poor concentration.
Brain & Memory
Post-mortem studies keep finding substantial Alzheimer's pathology in people who were cognitively intact when they died. The concept built to explain that has practical implications.
Brain & Memory
It is generated by the brain rather than the ear, there is no cure, and the treatments with real evidence target distress and attention rather than the sound itself. That is more useful than it sounds.
Living Well
The documents matter less than the conversations. Most families making decisions in an intensive care unit have never been told what the person would have wanted, and are asked to guess.
Preventive Care
A hospital is where you go to be treated and also where older people lose the ability to walk, become confused, acquire new medications and lose old ones. Some of that is avoidable.
Preventive Care
The rash is the visible part and the least important. What determines how bad an episode is turns out to be how quickly antiviral treatment starts and how old you are.
Living Well
Excess deaths in heatwaves and cold snaps fall overwhelmingly on people over 75. The physiology behind that is specific, and most of the protective measures have to be taken before the weather arrives.
Heart & Metabolic
A drop in blood pressure on standing affects a large minority of older adults, causes falls and fainting, and is missed because blood pressure is almost always measured sitting down.
Brain & Memory
It presents as physical symptoms and as worry about health, it is frequently written off as a personality trait, and it responds to treatment about as well as it does at any other age.
Heart & Metabolic
A falling eGFR alarms a great many people who have nothing seriously wrong, while the test that better predicts trouble is frequently not done at all.
Living Well
After several hundred articles about individual interventions, the honest summary is short, unglamorous, and considerably less interesting than the supplement industry would like.
