At 85 and healthy? Why more medicine may do more harm

[erronis]

https://medicalxpress.com/news/2026-06-healthy-medicine.html
by James H. Stein, MD



I don't think I've seen this perspective before. As I'm slowly approaching my actuarial EOL, this has a lot of relevance.

When a patient has made it to 85 years old in reasonable health, their instinct--and often their physician's--is to redouble prevention efforts, optimize every number and close every gap. I want to argue the opposite.

If you have made it to 85 and are healthy and living independently, you have won the game of life. The appropriate response is not more medicine. It is recognizing what got you there and being very careful not to break it. We have precious few interventions that can reliably extend an 85-year-old's lifespan (let alone their health span) but an infinite number of ways we can mess it up.

What winning the game actually means

Average life expectancy at birth in the United States is roughly 78 years. A healthy 85-year-old has outlived that mark by nearly a decade, and someone born in 1940, when life expectancy at birth was closer to 63 years, has outlived what the actuarial tables of their birth year would have predicted by more than two decades.

Something is working, likely their genetics and lifestyle behaviors, acting together with a huge dose of good fortune, none of which we fully understand. That humility should inform everything that follows. This is a patient who succeeded at survival--not one who failed prevention--and interventions calibrated for a 58-year-old in a randomized clinical trial do not apply to them in any straightforward way.

. . .

[Pinback]

1. "... there is a specific harm in converting a healthy older adult into a medical project."

Great article. As someone who doesn’t shun doctors but tries to maintain good health by way of lifestyle factors rather than pharmaceuticals, I appreciate this perspective.

[bamagal62]

14. My goal is to be on no medications

Unless absolutely necessary. I’m 64 and take no meds. I walk A LOT. I chose to walk to my eye doctor appointment today. 2 miles there and 2 miles back. I’m in Manhattan. So, I can choose to walk. Rarely do I take the subway or uber. I allow time to walk where I’m going.

[erronis]

16. Good for you!

I hope you don't get one of those diseases like I have (leukemia) that showed up in my 60s.

It's said that if nothing else gets you, cancer will.

[multigraincracker]

2. I think longevity is like diarrhea, it runs in your genes.

Both my parents lived to 90. Figure that might be me. All my doctors prescribe the same thing, keep moving.

[bamagal62]

8. My mom's side of the family

Live long lives. She’s 95. Her mom lived until 93. Her Aunt lived to 100. My Dad’s side do not live long lives. Many died in their 60s or 70s. I’m crossing my fingers I have the good ones! The fact that I look just like my mother gives me hope!

[bamagal62]

12. Moving is key.

It’s probably why the Japanese live long lives.

[erronis]

17. Just because I'm watching it and it fits with your comment - look up "Perfect Days"

Wonderful new film.

[bamagal62]

21. I need to watch.

I lived in Tokyo for 2 years. One of my favorite places!
We can learn a lot from their lifestyle.

[multigraincracker]

22. I'm 76 and run 3 to 5 miles 3 to 4 days a week.

Not fast, just steady. My usual pulse was 45bpm. One day it got down to 23bpm. Now have a pacemaker that kicks it up to 60. My doctor says I have a Senior Athlete heart.
But you never know, might get run over by a school bus.

[multigraincracker]

24. Saw a film about Japanese heart health.

Study showed they smoke and drink more than most but have the healthiest heart because they some kind of fermented soy beans that cleans the plaque out of veins. They also do not suffer age related dementia. I think it was called Nattokinas. ?spelling.

[bamagal62]

26. Natto?

I didn’t like it. And my kids wouldn’t touch it. But, the expat kids that were born there loved it. I guess it’s kind of like vegemite, an acquired taste!

[multigraincracker]

27. I eat all kinds of fermented food and drinks.

I kind of like sour taste.
Where do they buy it at? I’m going to start looking for it.
I saw a Bill Gates film about it. His father died of Alzheimer’s so he spent millions researching those things.

[bamagal62]

33. You should suss out

Natto and see if you like it!

[erronis]

34. Co-ops frequently sell natto. And miso and other fermented products.

I also like kimchi if not too spicy. One day a cute Korean worker in a deli gave me a Christmas gift of a gallon of special kimchi with oysters - all fermented together. I don't think I finished it....

https://en.wikipedia.org/wiki/Kimchi

[ultralite001]

3. If it's not broken...

Don't fix it...

Here's to another healthy decade or two or three for many of us...

[free of the stresses of the Mango Mussolini]...

Now in my 7th decade, I'm thinking of learning to dance [an activity frowned upon by my recently departed partner]...
I'm also looking into singing w/ the Resistance... They contacted me overnight, so I will check it out... The garden is
beginning to produce, so that will keep me busy. I'm working on some weather coding projects... I' m wishing I had
a bike to ride...Hank, our goofy dog, just turned 3 + is a lively companion. My kids + grandkids seem to be thriving...
Music + the arts seem to sustain us all..To be so blessed astounds me each + every day...Folks here continue to
inspire + for that I thank you all...

Shall we dance???

[erronis]

4. Wow - that took me back at least 60 years.

The songs and images from that musical are embedded.

[cate94]

15. Omg

I actually had that song in my head last night, for no apparent reason!

[multigraincracker]

28. I'm blessed with ADHD.

The HD part keeps me super busy. In my younger day I worked two jobs, had a business on the side working A full time job and took classes too.
I struggled in college and dropped out. Found a great psychiatrist that diagnosed it when I was in my late 30s. Ask if I went to college and I had but did terrible. He told me to go back and sit in the front row and I’d get a A s. I did and graduated magna cum laude.
Interesting life with lots of sympathy for others that struggle.

[kellytore]

5. I would argue that the age should be 75 not 85.

I also believe many medical tests such as a colonoscopy should not be given to people in their 70's.

[Pinback]

6. At my last annual checkup, my young doctor said,

“Your colonoscopy next year will probably be your last one, assuming everything checks out OK.”

“Great!“ I said, and then realized I’m no longer likely to live long enough to develop colon cancer. Good news, I guess.


When I got home I realized I should have said, “I’ll be glad to get that behind me!”

[multigraincracker]

29. Same here. Just glad I went to the eye doctor.

Caught my glaucoma early enough to save my sight.

[bamagal62]

9. My uncle died

During a colonoscopy. A perforation. Early 60s.

[erronis]

18. I'm very sorry to hear that. It can happen at any age, but we get a lot of them as we age.

[bamagal62]

23. I will say this was many years ago before it became routine.

However, I resisted mine for years because of it. When I would tell my doctors why, they would say, ok. Finally, though, they talked me into it. But, stressed me out like you would not believe!

[anciano]

7. A thought provoking OP.....

I personally believe that life is like a game of cards and that it plays out according to the hand that fate deals you.

[bamagal62]

10. I so agree!

I had a good friend that was active, never smoked, and took great care of herself. Died of lung cancer.

[erronis]

11. And when the opponent flips over his winning card.

I agree with your sentiment. We're in the game until we aren't.

[multigraincracker]

30. The cards are shuffled randomly. You only

control the hand you are dealt.

[TygrBright]

13. I admit to HEAVY confirmation bias in favor of the article...

...which I read in its entirety.

I also have a lot of ambivalence about the modern obsession with treating every possible ache and pain as we get older.

We're getting older. Our maintenance schedule is more demanding (moderate exercise, focuse on flexibility! minimize potential opportunities for injury! moisturize that saggy skin!) and our bits and pieces are accumulating wear.

Occasional moderate pain is, in fact, NORMAL as we age. It will likely be different for each of us. Sometimes it's easily treated with mild anti-inflammatory, perhaps some focused exercise. Sometimes meditation, distraction, and bubble baths may be the best we can manage.

Of course if it becomes acute and/or persists for longer than a couple of days, it's worth looking into. But trying to treat and/or avoid every source of occasional mild to moderate pain often increases anxiety, involves medication risks, costs time and effort that may not be worth it if we can be patient and wait.

I am not a profit center for the corporate "health care" industrial complex.

insubordinately,
Bright

[erronis]

20. I like your philosophy.

I'd like to think that aging is something to be expected. There are the good parts and the not-so-good. Pain is probably the worst, especially if it is unnecessary.

[multigraincracker]

31. I'd rather deal with the pain than take pain pills.

Don’t like how they make me feel.

[Dr. T]

19. I'm comfortable with my mortality.

Doctors and medical science have no answers for most of my chronic ailments. Big pharma will gladly keep you alive long enough to take your last dollar.

I've known people who lived into their late 80's and 90's. Their quality of life faded significantly. So I’ll blow off my colonoscopy, drink another beer, eat another ribeye, and enjoy the ride.

[lostnfound]

25. Regarding colonoscopy, I've wondered whether the damage to the microbiome from the prep...

might be counterproductive in some cases.
Microbiome in the gut is supposed to be pretty important, they keep learning more. Of course it can be repopulated to some extent (i.e., from yogurt or kimchee etc.), but there are so many types of bacteria that contribute to human health which are not necessarily easily repopulated.

[multigraincracker]

32. I never minded getting one. My brother

never got another after the first. He spent thousands on a full body scan instead.