Staying well at your age:

People are staying young longer than they used to. As the human life span slowly increases, so do the starting points of middle and old age, a shift that's forcing a reconsideration of which health-care issues are most important for any given age. 'What was once a concern for people in their 40s should sometimes now be a worry for those in their 50s, and on up the line," says Warren Sanderson, Ph.D., of the State University of New York in Stony Brook, who wrote about that shift in the British journal Nature. Unfortunately, few doctors and patients are keeping up with those changes. For example, more people are staying sexually active - and thus at risk for sexually transmitted diseases - into their 60s, 70s, and beyond. Yet few doctors talk with their "older" patients about that hazard. Similarly, some doctors still routinely counsel patients over age 75 or 80 to forgo certain drugs and operations, although research increasingly shows that such steps can often be safe and effective for them. It's not just the new definition of "old" that makes it hard to get age-appropriate care. Some major age-related changes are subtle or contrary to popular belief:

* The classic symptoms of many health problems - such as the crushing chest pain of a heart attack - are often replaced by less dramatic complaints in older people, such as weakness, nausea, and less-typical chest pain. Other symptoms, such as headache, joint pain, and insomnia, can signal different concerns at different ages.

* Exercise requirements change gradually with age, shifting from mainly aerobic activities such as jogging and biking to those that maintain strength and flexibility.

* Dietary problems often shift from eating too much food to consuming too little after age 70 or so. While younger people frequently need to control their appetite, older individuals may need to stimulate it.

* The recommended tests, exams, and immunizations of the routine checkup vary with age. For example, mammography is most beneficial for women in their 50s and 60s. And prostate-cancer screening becomes increasingly needless as men age.

The table, "Health Care Through the Ages," shows how annual exams, symptoms, and exercise and dietary needs change with age. Here we give further guidance on getting the right care for your age.

New Recommendations

Some doctors still tell people older than 75 or so to decline procedures such as coronary-bypass surgery and cancer radiation or chemotherapy because they assume older patients can't withstand the trauma and won't live long enough to enjoy the benefits. But research shows that such invasive steps can be safe and effective for otherwise reasonably healthy people even in their 70s and beyond. For example, studies published in 2002 and 2003 found that aggressive treatment of lung and colon cancer in older people lengthened their life and was no riskier than in younger people. And several studies have shown that the risks and benefits of knee- and hip-replacement surgeries in 80- to 90-year-olds are comparable to those in other people. For treatment decisions, "it's not your age in years that's most important but your overall health," says Mary Beth Hamel, M.D., a researcher at the Beth Israel Deaconess Medical Centre in Boston who has written about the pros and cons of surgery in older people.



Some doctors also avoid treating certain problems in older people - such as high cholesterol, sugar, and blood-pressure levels - partly because they assume such problems are unimportant at that age and partly because of the greater risks of drugs in older folks. But research generally confirms that those elevations still harm people in their 70s and beyond and should often be treated.

Moreover, extra precautions can often minimize the risks enough to make treatment worthwhile. Ask your doctor if you can start a new drug at a lower-than-usual dosage and increase it only if necessary. Watch for possible side effects such as fatigue, confusion, constipation, incontinence, and unsteady gait, which are often dismissed as normal aspects of aging. Your doctor may be able to minimize those effects by reducing the dosage or substituting another drug. And be sure to review all your medications with your doctor at every routine office visit.

Signs of Changing Times

Several conditions begin with one set of symptoms in younger people, another in older people. For example, the classical chest-clutching heart attack is typical only before age 75 or so, especially in men. The subtler symptoms in older people, especially women, may partly explain why they're less likely to receive timely treatment. And depressed older people are less apt to admit depression and more apt to be irritable or agitated. So it's especially important for doctors to make a more comprehensive assessment of older patients' emotional health.

In other cases, common symptoms stem from different cures, depending on age. Before age 50, for example, headaches typically indicate excessive stress or migraines; after 50, however, the chance that they're caused by more serious problems, ranging from hypertension to aneurysm, or bulging blood vessels, rises sharply. So older people who start getting severe or frequent headaches should seek out doctor instead of popping a pill and dismissing their pain as "just a headache."

Similarly, while sleep problems increase with age, so does the likelihood that they stem from either medication or disorders, such as sleep apnea or prostate enlargement. In addition, sleep patterns naturally change with age: Young people's sleep cycle favours staying up at night and sleeping late, while the opposite tendency develops in later years.

And sleep becomes increasingly fragmented, shallow, and easily disturbed with age.

Exposure to outdoor light in the early morning and wearing sunglasses or staying indoors in the late afternoon can push the sleep cycle forward, helping young people fall asleep and wake up earlier. Midday exposure can soldify the cycle in middle age. And getting outdoors in the late afternoon and early evening, staying in well-lit areas until bedtime, and wearing sunglasses or staying inside in the early morning can help older people stay up longer and wake up later .

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