Practically everything is considered a medical problem these days. Anything from worrying about school to being chronically late can get you a diagnosis and a prescription. The last thing we need is to treat ageing itself as some kind of terrifying disease.
Of course, we all want to live long and healthy lives. But we must face the inevitability that we will all die of something. For many, this will be caused by some kind of disease, condition or even a terrible accident. But, provided you don’t get hit by the proverbial bus, everyone physically wears out at some point. As you age, so too will your organs begin to reduce in their efficacy, until they eventually shut down altogether.
Last month, a friend of mine – let’s call her Jane – described to me her experience of an annual blood test. Jane is 73, slim, works out at the gym almost every day and eats healthily. She says she feels very fit. So she was in for a shock when she was called in for a face-to-face meeting with her GP to discuss some of her ‘abnormal’ test results. The doctor advised her that she was actually riddled with disease – chronic kidney disease (CKD), pre-diabetes and high cholesterol, meaning a high risk of heart disease. After receiving this unexpected and scary news, her blood pressure was taken. Perhaps unsurprisingly, given the surprise she’d just received, she was also diagnosed with hypertension, putting her at an increased risk of heart attacks and strokes.
The NHS is keen to let us know that we don’t age, so much as become diseased. Over the age of 70, you are likely to be diagnosed with at least one or probably more of the following: pre-diabetes, CKD, hypertension, high cholesterol, chronic obstructive pulmonary disease, cardiovascular disease, prostate cancer, or some other type of cancer, and possibly dementia. Most of these diagnoses result from the fact that test results more often than not fail to take age into account.
A good example of this is CKD. In 2008, the National Institute for Health and Care Excellence (NICE) introduced guidance measures for different stages of kidney disease. What it didn’t do is adjust these for age. Consequently, kidney disease has been found to be more prevalent in those over the age of 60 when compared with the rest of the general population. According to recent estimates from researchers at Johns Hopkins University, more than half of seniors over the age of 75 are believed to have kidney disease. However, not all doctors agree with the NICE guidance. In 2016, an article in the Clinical Biochemist Reviews concluded that ‘in subjects older than 65, CKD category 3A1’, usually meaning a mild to moderate loss of kidney function, ‘is associated with a trivial risk of mortality’. The report proposed an alternate classification for over-65s, under which my friend Jane wouldn’t have been diagnosed with CKD.
What’s more, while catching a disease in its early stages is often a good thing, many of the conditions discovered early are unlikely to advance in older people. For example, pre-diabetes is estimated to affect 50 per cent of people over the age of 65. However, according to one recent study, over-71s with pre-diabetes were more likely to remain in this intermediate state rather than progress into actual diabetes. Many would even return to normal glucose values within six-and-a-half years. The study concluded that having pre-diabetes as an older adult was probably less important than having it when young.
This overdiagnosis can lead to unnecessary procedures, with more risks than benefits. For example, prostate-cancer detection has increased massively, but this is not always a good thing. In a new book by Suzanne O’Sullivan, The Age of Diagnosis: Sickness, Health and Why Medicine Has Gone Too Far, she points out that many prostate-cancer screening programmes don’t necessarily save lives. For every thousand men screened, as many as 20 receive unnecessary treatment. She also highlights that 70 per cent of autopsies carried out on men in their 60s, who died for reasons other than prostate cancer, revealed undiagnosed prostate cancer. Most of these were chance discoveries, and the cancer would likely never have caused these men any significant health problems.
Hypertension is yet another ‘disease’ that older people are routinely diagnosed with. The NHS estimates that 60 per cent of people over 65 have been diagnosed with the condition. But, like CKD, it is a diagnosis that is not routinely adjusted for age. A normal blood pressure range for Jane, at 73, would be 139 / 68. Her average blood pressure measured a respectable 137 / 77. According to the NHS guidance, anything over 135 / 80 is considered hypertension – hence, Jane and many other older people are unnecessarily diagnosed.
The story is similar for high cholesterol. In 2021, 65 per cent of women and 48 per cent of men over 65 were diagnosed with high cholesterol, although it is well-documented that cholesterol rises with age without necessarily being accompanied by the usual increased risk of heart attacks or strokes.
Many will argue that this overdiagnosis is needed to prevent hospital admissions. In reality, the proportion of older people admitted to hospital has been rising, not decreasing, in the UK over the past 20 years. Between 1999 and 2019, rates of hospital admissions in England and Wales increased by 45.6 per cent for 60- to 74-year-olds and by 74.3 per cent for those over 75. This is way out of proportion to the rest of the population, with over-65s making up 15.8 per cent of the general population in 1999 and 19 per cent in 2022. On top of this, unnecessary hospital admissions rose by 107 per cent for people aged between 65 and 69, and 119 per cent for those aged 75 to 79 between 2003 and 2018.
Treating older people as inherently unwell creates a health crisis that simply doesn’t exist. It also stigmatises ageing as a disease, forcing otherwise fit and active older people to live under a cloud of unnecessary anxiety. We should stop labelling getting old as an illness, and let people age gracefully, healthily and without fear.
Sheila Lewis is a retired management consultant and a patient member of Guy’s and St Thomas’ NHS Foundation Trust.
