A recent trial presented at the ESC meeting addresses the question of reducing blood pressure meds in the elderly. It’s an important study—for numerous reasons.
This chimes with my personal experience. A frail elderly relative, inclined to fall over, was started on BP-lowering meds and immediately started falling over more. Not a good outcome.
Critique of John Mandrola’s Opinions on Antihypertensive Use in the Elderly
1. The fragility of the “preventive” premise
Mandrola states that antihypertensive drugs are essential in middle-aged patients so that they can reach 80 or 90 years of age, but that they lose their purpose after that point. Although appealing, this reasoning oversimplifies reality.
- Vascular risk does not disappear at 90. On the contrary, the incidence of stroke and heart failure remains high, and even a small preventive effect can mean preserving autonomy for months or years, something crucial for patients and families.
- Secondary prevention (patients with prior MI, stroke, or HF) cannot be confused with primary prevention. Many elderly patients continue to benefit from rigorous blood pressure control, not for longevity but for quality of life and reduced disability.
---
2. The overvaluation of “common sense medicine”
Mandrola repeatedly appeals to “common sense” as a guide. In geriatrics, this is dangerous:
- What seems like common sense (“less medication is always better”) can be misleading. Many octogenarians and nonagenarians, even frail ones, tolerate antihypertensives well—especially in low doses—and benefit from reduced risk of disabling stroke.
- Geriatric physiology is complex: orthostatism, variations in cardiac output, renal decline. Generalizing based on “common sense” may lead to undertreatment.
---
3. Limitations of RETREAT-FRAIL that he downplays
The study is important, but Mandrola interprets it in a biased way:
- Extremely selective population: 10,000 screened to enroll 1,000. Results are hardly generalizable, especially to community-dwelling older adults (not only nursing home residents).
- Very high-mortality population: 60% dead within 3 years. Under such conditions, it was indeed unlikely to see mortality differences. The absence of difference does not mean absence of benefit in subgroups (less frail, less polymedicated).
- Already low baseline BP (113 mmHg). The potential for benefit was minimal. It cannot be extrapolated that older hypertensive patients with SBP of 150 mmHg should loosen control.
---
4. Disregard for clinical nuances
Mandrola lumps all adults “over 80–90” together, ignoring heterogeneity:
- A 90-year-old, lucid, independent, with preserved functional reserve, may want active treatment to reduce stroke risk.
- A terminally ill older person, with extreme frailty and polypharmacy, may indeed benefit from deprescribing.
The critique here is that he universalizes management, whereas geriatrics is, by definition, about individualization.
---
5. The bias against “preventive medicine in the elderly”
He argues that there are no positive trials in nonagenarians. This is true in terms of overall mortality, but it omits that:
- Trials such as **HYVET** (patients ≥ 80 years) clearly showed benefits of treating hypertension in outcomes like stroke.
- The goal in geriatrics is not only to “live longer,” but to **live better and die better**. Avoiding a disabling stroke may be more valuable than extending life by a few months.
---
6. The final message: good, but poorly substantiated
I agree with Mandrola when he emphasizes **reducing the burden of being a patient**: appointments, tests, polypharmacy. That is central in geriatric practice.
But his reasoning sounds simplistic: he takes a negative trial in an ultra-frail population and turns it into a near-universal rule for deprescribing. The practical result may be dangerous—encouraging less experienced clinicians to stop antihypertensives without proper clinical and functional assessment.
---
Critical conclusion
John Mandrola is right to draw attention to polypharmacy and to the need to reconsider preventive drugs in very frail elderly patients. However, he overreaches by using a negative study as justification for generalized conduct.
Geriatrics requires **individualization, nuance, and contextual analysis**: chronological age is not enough, and the absence of a mortality gain does not negate benefits in preventing disability. Taken literally, his discourse risks trivializing hypertension in older adults—something we know is devastating in terms of stroke and loss of autonomy.
I’ve always tried to be reductionist for myself. If diet and exercise can treat my issue, I’ll do it no other way. I appreciate the careful demedicating though, and applaud those who know enough about their care (or surround family knowledge) not to waste time on unneeded tests.
I agree with the takeaway from this study, but for different reasons.
The authors postulated testing for 25% RRR in mortality to show superiority….in a trial involving a reduction in med Rx. That seemed like an extremely unnecessary high bar.
The proposed strategy would have reduced polypharmacy in a frail elderly population, as you pointed out. That alone would have been a sufficient win in my book. I’m disappointed the trial wasn’t structured as non-inferiority for efficacy, and superiority for safety such as symptomatic hypotension and injurious falls.
In the end, this trial “failed to show a difference” in mortality….but there certainly did not seem to be a clinical outcome penalty for reducing BP meds. That is good enough for me, for the reasons you mentioned, and will be incorporated into my practice.
No mention of the many natural resources to try that come with very little risk and no blow-back. Take your blood pressure readings over a week, everyday maybe 3-4 times a day. After sitting, or moving around, or walking, in the morning, in the evening. You might have 25-30 readings and they could be over quite a large range. So which one is your blood pressure? ALL of them...not the one time reading the nurse or doctor takes in an office. Using that lone figure as your never-to-be-questioned BP is outrageous.
My wife is on a BPM and it gets scary when the pressure falls below 90 on the upper (systolic) reading. That is not safe in my view. Oh, but wait, you have other drugs to balance things out. What a freaking joke medicine has become. I am elderly and on NO meds. There is no reason to be.
Crixcyon: elderly & on NO meds is truly exceptional & something to be thankful for
Agreed the one time reading in the practitioners office is often inaccurate & shouldn't be used for determining anyone's BP drug needs.
No one on maintenance meds needs to take their BP 3-4 times a day or deal with 25-30 readings. Establish a routine (same time, same place, same circumstances) for daily BP readings. Record 4 readings at one sitting. Throw out the high & low. Average the other two. Do this for a week then average the daily averages. Now you know your BP. Do this each time you have a med change. It's a bit complicated but not truly hard.
"elderly & on NO meds is truly exceptional & something to be thankful for"
Remember that long before blood pressure medication, there were more than a few who lived to 90 and beyond: John Adams (90), Oliver Wendell Holmes Jr. (93), George Bernard Shaw (94), Pablo Casals (96), Frank Lloyd Wright (91), Sophocles (90).
Feeding pills to frail elderly is always exciting. One never knows when the next bout of aspiration will occur. As the good doctor says, food is more important than pills at that age.
With an average systolic of 113 wouldn't we say they are over medicated even if they were 40. I would find more evidence in this trial if the average systolic were 140. So the question is do you treat an 85 year old in good health if their systolic is 140? Sprint says you lower mortality if you do. I would guess that you do not treat , but we don't have evidence for that conclusion.
This column reminds me of a recent story about a possible link between overmedication and fall-induced mortality in the elderly: Paula Span, "Why Are More Older People Dying After Falls?" The New York Times, 7 September 2025, https://www.nytimes.com/2025/09/07/health/falls-deaths-elderly-drugs.html.
I think you have to distinguish between 90 year olds who are living in a nursing home and those who are out living independently in the community. The former on average will have 2 more years and the latter who knows, but in any case will not have the same degree of frailty. Doctors have to keep cautious in every patient taking anti-hypertensives which are the underlying cause of orthostatic hypotension more than 90% of the time. We don't ask patients to have follow up visits for no reason.
"The former on average will have 2 more years AND THE LATTER WHO KNOWS"
A 90-year-old can expect, on average, about 3.9 more years (men) and 4.6 more years (women) (Source: Social Security) . . . so the average life expectancy for a 90 year-old "living independently in the community" is only a little longer--3.9 to 4.6 years--than for one in a nursing home (2 years).
Great analysis. I worked in a PACE primary care and every time one of my patients with severe heart failure would go to the hospital, even if it was for syncope, they would send him home with lisinopril or something similar, even though he was 80 and often hypotensive. They were probably thinking “his stupid primary care NP doesn’t even know GDMT.” 😂 I’m glad that you considered it a positive trial even though mortality was not improved, I agree that sometimes the best thing we can do is not to do more harm. Frail patients are already vulnerable to any little thing that wants to kill them.
I am a PT. I see this all the time in my patients. I call it the over medicalization of the elderly. I have a friend, 94, and she gets all the screening. Carotid arteries, bone density etc. I ask myself, to what end? If we all of a sudden found her bone density at risk, would you treat that? She has kidney issues, has survived cancer two times, is on synthetic hormone replacement (might be the best thing she ever did for herself), insulin and is sharp as a tack. What will be her downfall I have no idea because she is organized, independent and all there. So to screen this person is a waste of medical dollars and doesn't credit her with a lifestyle that has lead to solid bones at 94 and carotid arteries that are open and clear. But her docs keep medicalizing her. And it's more and more for her to drive. Then add the phone refilling of meds that the VA relies on which is stupid. If you aren't there to answer and know what meds you need, it's incorrect. Again costing more money and stress in a 94 yo rules follower! Drives me nuts! My MIL went "Barbara Bush" and stopped medical care. She lived life and did her routines and any medical care they would have shoved on her wouldn't have saved her at 90 from passing. Good for her!
My father is 97 years old and a year ago was living out of state with wife with severe dementia . I urgently visited because I was concerned I wasn't getting the story over the phone and admitted him urgently with hypertensive heart failure.
His physicians missed the fact that he had severe edema to the point that he was oozing literally from his hips. He ends up on a Lasix drip, etc. creatinine rises to almost 3, troponin bumps but EF is normal with rate controlled afib on no rate meds. His baseline was 2.2 or 2.3. He's been in assisted living near us in Texas for the last year seeing my CHF colleagues. He's given medicines every day and can't drive to Dunkin' Donuts or McDonald's. He's lost 50 pounds. He's probably at ideal body weight, creatinine is 2.0 and he has NO edema. He is status post knee replacement 20 years ago and he's always in a hurry with nowhere to go. He has fallen a few times but his blood pressure in the clinic is 150/80.
His physicians were considering increasing his antihypertensives. I reminded them that "the enemy of good is perfect".
(I actually hired his CHF doctor 20 years ago which the doc reminds me at every visit. )
We did not change the meds.
Subsequently Dad had a diverticular bleed that required urgent transfusion IN the ambulance, developed a huge neck abscess from picking skin keratosis requiring surgery and he fell and hit his head while bending over to give his little dog food. ER CT head and neck neg !
The EMS driver said he recognized me and I asked if it was because I was a doctor ? He said no its because you seem to be in a lot of these pickups!
Dad survived all of these events and now with physical therapy he walks 1200 feet with a walker at one time. He reminds me that is multiple football fields. Good job to the CHF docs.
I outlined this saga of Medicare fund depletion only to point out or ask what would've happened in any of these circumstances if his baseline blood pressure was 120/80 as opposed to 150/80?
There was a study, looking at 90 year olds who lived in a community and they compared them to other others who died in their 80s . The people lived there since their 50s as I recall.
Markers for longevity were mild obesity( head start if you get a severe illness and excludes severe underlying illness probably); mobility (that's obvious , no falls) ; elevated blood pressure (dads story); and and alcohol use (well that's interesting isn't it? )
In in my rural clinics, the patients reminded me often to not "Fix what isn't broken"
Matt: Good on you for how you care for your father!
The study on 90 year olds you refer to is perhaps one of the most comprehensive, well run studies on aging, especially dementia. It is primarily marred by the fact that the population is ethnically & socioeconomically not very diverse. But it does she a lot of light on what contributes to longevity & what does not. It also reveals how little is well understood about dementia
Here is a link for those who would like to know more about this ongoing study
A study of residents in a SoCal retirement community (Leisure World / Lauguna Woods CA ); 14,000 people answer annual questionnaire about their health, habits, diet, vitamins… in 1981. In 2014 with a NIH grant they looked for these folks who were still alive and over 90 yrs old. The found over 1,600 who were still alive & enrolled them in the 90+ study. They get a full physical & mental exam(hour long battery of cognitive/ memory tests every 6 months. Dr Claudia Kawas established the Leisure World Cohort Study to monitor the health and well-being of people 90 and older in Laguna Woods, California. The 90+ Study, launched in 2003, is one of the largest research efforts of its kind, following more than 2,000 people aged 90 and older — the fastest growing age group in the U.S.
Short answer is -- it depends!! My impression is yes, one can consume alcohol in moderations (1 drink or less per day for men) without significant adverse health impact.
If a person is 21, not drinking at all probably has the most health benefit due to the wide range of multiple risk factors associated with alcohol consumption & scant evidence that it is helpful. But the person who consumes a moderate amount of alcohol and has not already died or developed some alcohol related pathology, it appears that there in not much benefit in stopping drinking; & there may actually be some benefit to a low level of alcohol consumption.
That said, there are lots of confounding factors butI think it is safe to say that consuming more than one drink per day is not good for anyone at any age!
I’ve suspected this for a while as many of the patients I see in our rural hospital are having syncope events that seem related to hypotensive problems. If the change was only 4mmhg then I’d say there’s not actually harm to reducing the amount and/or dosage of bp meds elderly take.
I used to work with a fantastic geriatrician who talked about this and the benefit of a simple cup of coffee to raise bp to a safer level, endearingly calling it “fix-a-flat”
I expect lipid drugs provide little benefit in this group as well. Also these facilities sometimes charge more as more meds are managed. So cost are higher for less benefits. My father was fainting for low BP and we had to ask the doctor to stop BP meds while doctor was blaming water intake.
This chimes with my personal experience. A frail elderly relative, inclined to fall over, was started on BP-lowering meds and immediately started falling over more. Not a good outcome.
Critique of John Mandrola’s Opinions on Antihypertensive Use in the Elderly
1. The fragility of the “preventive” premise
Mandrola states that antihypertensive drugs are essential in middle-aged patients so that they can reach 80 or 90 years of age, but that they lose their purpose after that point. Although appealing, this reasoning oversimplifies reality.
- Vascular risk does not disappear at 90. On the contrary, the incidence of stroke and heart failure remains high, and even a small preventive effect can mean preserving autonomy for months or years, something crucial for patients and families.
- Secondary prevention (patients with prior MI, stroke, or HF) cannot be confused with primary prevention. Many elderly patients continue to benefit from rigorous blood pressure control, not for longevity but for quality of life and reduced disability.
---
2. The overvaluation of “common sense medicine”
Mandrola repeatedly appeals to “common sense” as a guide. In geriatrics, this is dangerous:
- What seems like common sense (“less medication is always better”) can be misleading. Many octogenarians and nonagenarians, even frail ones, tolerate antihypertensives well—especially in low doses—and benefit from reduced risk of disabling stroke.
- Geriatric physiology is complex: orthostatism, variations in cardiac output, renal decline. Generalizing based on “common sense” may lead to undertreatment.
---
3. Limitations of RETREAT-FRAIL that he downplays
The study is important, but Mandrola interprets it in a biased way:
- Extremely selective population: 10,000 screened to enroll 1,000. Results are hardly generalizable, especially to community-dwelling older adults (not only nursing home residents).
- Very high-mortality population: 60% dead within 3 years. Under such conditions, it was indeed unlikely to see mortality differences. The absence of difference does not mean absence of benefit in subgroups (less frail, less polymedicated).
- Already low baseline BP (113 mmHg). The potential for benefit was minimal. It cannot be extrapolated that older hypertensive patients with SBP of 150 mmHg should loosen control.
---
4. Disregard for clinical nuances
Mandrola lumps all adults “over 80–90” together, ignoring heterogeneity:
- A 90-year-old, lucid, independent, with preserved functional reserve, may want active treatment to reduce stroke risk.
- A terminally ill older person, with extreme frailty and polypharmacy, may indeed benefit from deprescribing.
The critique here is that he universalizes management, whereas geriatrics is, by definition, about individualization.
---
5. The bias against “preventive medicine in the elderly”
He argues that there are no positive trials in nonagenarians. This is true in terms of overall mortality, but it omits that:
- Trials such as **HYVET** (patients ≥ 80 years) clearly showed benefits of treating hypertension in outcomes like stroke.
- The goal in geriatrics is not only to “live longer,” but to **live better and die better**. Avoiding a disabling stroke may be more valuable than extending life by a few months.
---
6. The final message: good, but poorly substantiated
I agree with Mandrola when he emphasizes **reducing the burden of being a patient**: appointments, tests, polypharmacy. That is central in geriatric practice.
But his reasoning sounds simplistic: he takes a negative trial in an ultra-frail population and turns it into a near-universal rule for deprescribing. The practical result may be dangerous—encouraging less experienced clinicians to stop antihypertensives without proper clinical and functional assessment.
---
Critical conclusion
John Mandrola is right to draw attention to polypharmacy and to the need to reconsider preventive drugs in very frail elderly patients. However, he overreaches by using a negative study as justification for generalized conduct.
Geriatrics requires **individualization, nuance, and contextual analysis**: chronological age is not enough, and the absence of a mortality gain does not negate benefits in preventing disability. Taken literally, his discourse risks trivializing hypertension in older adults—something we know is devastating in terms of stroke and loss of autonomy.
I’ve always tried to be reductionist for myself. If diet and exercise can treat my issue, I’ll do it no other way. I appreciate the careful demedicating though, and applaud those who know enough about their care (or surround family knowledge) not to waste time on unneeded tests.
I agree with the takeaway from this study, but for different reasons.
The authors postulated testing for 25% RRR in mortality to show superiority….in a trial involving a reduction in med Rx. That seemed like an extremely unnecessary high bar.
The proposed strategy would have reduced polypharmacy in a frail elderly population, as you pointed out. That alone would have been a sufficient win in my book. I’m disappointed the trial wasn’t structured as non-inferiority for efficacy, and superiority for safety such as symptomatic hypotension and injurious falls.
In the end, this trial “failed to show a difference” in mortality….but there certainly did not seem to be a clinical outcome penalty for reducing BP meds. That is good enough for me, for the reasons you mentioned, and will be incorporated into my practice.
No mention of the many natural resources to try that come with very little risk and no blow-back. Take your blood pressure readings over a week, everyday maybe 3-4 times a day. After sitting, or moving around, or walking, in the morning, in the evening. You might have 25-30 readings and they could be over quite a large range. So which one is your blood pressure? ALL of them...not the one time reading the nurse or doctor takes in an office. Using that lone figure as your never-to-be-questioned BP is outrageous.
My wife is on a BPM and it gets scary when the pressure falls below 90 on the upper (systolic) reading. That is not safe in my view. Oh, but wait, you have other drugs to balance things out. What a freaking joke medicine has become. I am elderly and on NO meds. There is no reason to be.
Crixcyon: elderly & on NO meds is truly exceptional & something to be thankful for
Agreed the one time reading in the practitioners office is often inaccurate & shouldn't be used for determining anyone's BP drug needs.
No one on maintenance meds needs to take their BP 3-4 times a day or deal with 25-30 readings. Establish a routine (same time, same place, same circumstances) for daily BP readings. Record 4 readings at one sitting. Throw out the high & low. Average the other two. Do this for a week then average the daily averages. Now you know your BP. Do this each time you have a med change. It's a bit complicated but not truly hard.
"elderly & on NO meds is truly exceptional & something to be thankful for"
Remember that long before blood pressure medication, there were more than a few who lived to 90 and beyond: John Adams (90), Oliver Wendell Holmes Jr. (93), George Bernard Shaw (94), Pablo Casals (96), Frank Lloyd Wright (91), Sophocles (90).
Feeding pills to frail elderly is always exciting. One never knows when the next bout of aspiration will occur. As the good doctor says, food is more important than pills at that age.
With an average systolic of 113 wouldn't we say they are over medicated even if they were 40. I would find more evidence in this trial if the average systolic were 140. So the question is do you treat an 85 year old in good health if their systolic is 140? Sprint says you lower mortality if you do. I would guess that you do not treat , but we don't have evidence for that conclusion.
This column reminds me of a recent story about a possible link between overmedication and fall-induced mortality in the elderly: Paula Span, "Why Are More Older People Dying After Falls?" The New York Times, 7 September 2025, https://www.nytimes.com/2025/09/07/health/falls-deaths-elderly-drugs.html.
I think you have to distinguish between 90 year olds who are living in a nursing home and those who are out living independently in the community. The former on average will have 2 more years and the latter who knows, but in any case will not have the same degree of frailty. Doctors have to keep cautious in every patient taking anti-hypertensives which are the underlying cause of orthostatic hypotension more than 90% of the time. We don't ask patients to have follow up visits for no reason.
"The former on average will have 2 more years AND THE LATTER WHO KNOWS"
A 90-year-old can expect, on average, about 3.9 more years (men) and 4.6 more years (women) (Source: Social Security) . . . so the average life expectancy for a 90 year-old "living independently in the community" is only a little longer--3.9 to 4.6 years--than for one in a nursing home (2 years).
That's why, at the tender age of 77, I have stopped all my BP medications. My BP really hasn't changed when I did so.
Great choice. You may live another 25 years.
I hope so with a lovely 11-year-old daughter (it's a long story)!
If you're 77 with a 11 year-old daughter, we need to be studying YOU, not frail nursing home patients.
Great analysis. I worked in a PACE primary care and every time one of my patients with severe heart failure would go to the hospital, even if it was for syncope, they would send him home with lisinopril or something similar, even though he was 80 and often hypotensive. They were probably thinking “his stupid primary care NP doesn’t even know GDMT.” 😂 I’m glad that you considered it a positive trial even though mortality was not improved, I agree that sometimes the best thing we can do is not to do more harm. Frail patients are already vulnerable to any little thing that wants to kill them.
Here's a clinical report on a successful deprescribing project in the post-acute care setting that mentions models for reducing polypharmacy in the elderly: https://journals.lww.com/jaanp/fulltext/2025/02000/a_nurse_practitioner_led_deprescribing_bundled.9.aspx
I am a PT. I see this all the time in my patients. I call it the over medicalization of the elderly. I have a friend, 94, and she gets all the screening. Carotid arteries, bone density etc. I ask myself, to what end? If we all of a sudden found her bone density at risk, would you treat that? She has kidney issues, has survived cancer two times, is on synthetic hormone replacement (might be the best thing she ever did for herself), insulin and is sharp as a tack. What will be her downfall I have no idea because she is organized, independent and all there. So to screen this person is a waste of medical dollars and doesn't credit her with a lifestyle that has lead to solid bones at 94 and carotid arteries that are open and clear. But her docs keep medicalizing her. And it's more and more for her to drive. Then add the phone refilling of meds that the VA relies on which is stupid. If you aren't there to answer and know what meds you need, it's incorrect. Again costing more money and stress in a 94 yo rules follower! Drives me nuts! My MIL went "Barbara Bush" and stopped medical care. She lived life and did her routines and any medical care they would have shoved on her wouldn't have saved her at 90 from passing. Good for her!
My 98 year old father still goes regularly to his doctors. I don't know if he is trying to break his father's age of 101 before passing. Beats me.
Great review.
My father is 97 years old and a year ago was living out of state with wife with severe dementia . I urgently visited because I was concerned I wasn't getting the story over the phone and admitted him urgently with hypertensive heart failure.
His physicians missed the fact that he had severe edema to the point that he was oozing literally from his hips. He ends up on a Lasix drip, etc. creatinine rises to almost 3, troponin bumps but EF is normal with rate controlled afib on no rate meds. His baseline was 2.2 or 2.3. He's been in assisted living near us in Texas for the last year seeing my CHF colleagues. He's given medicines every day and can't drive to Dunkin' Donuts or McDonald's. He's lost 50 pounds. He's probably at ideal body weight, creatinine is 2.0 and he has NO edema. He is status post knee replacement 20 years ago and he's always in a hurry with nowhere to go. He has fallen a few times but his blood pressure in the clinic is 150/80.
His physicians were considering increasing his antihypertensives. I reminded them that "the enemy of good is perfect".
(I actually hired his CHF doctor 20 years ago which the doc reminds me at every visit. )
We did not change the meds.
Subsequently Dad had a diverticular bleed that required urgent transfusion IN the ambulance, developed a huge neck abscess from picking skin keratosis requiring surgery and he fell and hit his head while bending over to give his little dog food. ER CT head and neck neg !
The EMS driver said he recognized me and I asked if it was because I was a doctor ? He said no its because you seem to be in a lot of these pickups!
Dad survived all of these events and now with physical therapy he walks 1200 feet with a walker at one time. He reminds me that is multiple football fields. Good job to the CHF docs.
I outlined this saga of Medicare fund depletion only to point out or ask what would've happened in any of these circumstances if his baseline blood pressure was 120/80 as opposed to 150/80?
There was a study, looking at 90 year olds who lived in a community and they compared them to other others who died in their 80s . The people lived there since their 50s as I recall.
Markers for longevity were mild obesity( head start if you get a severe illness and excludes severe underlying illness probably); mobility (that's obvious , no falls) ; elevated blood pressure (dads story); and and alcohol use (well that's interesting isn't it? )
In in my rural clinics, the patients reminded me often to not "Fix what isn't broken"
That's the point
Matt: Good on you for how you care for your father!
The study on 90 year olds you refer to is perhaps one of the most comprehensive, well run studies on aging, especially dementia. It is primarily marred by the fact that the population is ethnically & socioeconomically not very diverse. But it does she a lot of light on what contributes to longevity & what does not. It also reveals how little is well understood about dementia
Here is a link for those who would like to know more about this ongoing study
https://www.youtube.com/watch?v=wqKfL3z5yM4 Living into your 90s. CBS 60 minutes Nov 18, 2020
A study of residents in a SoCal retirement community (Leisure World / Lauguna Woods CA ); 14,000 people answer annual questionnaire about their health, habits, diet, vitamins… in 1981. In 2014 with a NIH grant they looked for these folks who were still alive and over 90 yrs old. The found over 1,600 who were still alive & enrolled them in the 90+ study. They get a full physical & mental exam(hour long battery of cognitive/ memory tests every 6 months. Dr Claudia Kawas established the Leisure World Cohort Study to monitor the health and well-being of people 90 and older in Laguna Woods, California. The 90+ Study, launched in 2003, is one of the largest research efforts of its kind, following more than 2,000 people aged 90 and older — the fastest growing age group in the U.S.
Here is a more recent link: https://mind.uci.edu/research-studies/90plus-study/
So I can drink then? :)
Short answer is -- it depends!! My impression is yes, one can consume alcohol in moderations (1 drink or less per day for men) without significant adverse health impact.
If a person is 21, not drinking at all probably has the most health benefit due to the wide range of multiple risk factors associated with alcohol consumption & scant evidence that it is helpful. But the person who consumes a moderate amount of alcohol and has not already died or developed some alcohol related pathology, it appears that there in not much benefit in stopping drinking; & there may actually be some benefit to a low level of alcohol consumption.
That said, there are lots of confounding factors butI think it is safe to say that consuming more than one drink per day is not good for anyone at any age!
I’ve suspected this for a while as many of the patients I see in our rural hospital are having syncope events that seem related to hypotensive problems. If the change was only 4mmhg then I’d say there’s not actually harm to reducing the amount and/or dosage of bp meds elderly take.
I used to work with a fantastic geriatrician who talked about this and the benefit of a simple cup of coffee to raise bp to a safer level, endearingly calling it “fix-a-flat”
I expect lipid drugs provide little benefit in this group as well. Also these facilities sometimes charge more as more meds are managed. So cost are higher for less benefits. My father was fainting for low BP and we had to ask the doctor to stop BP meds while doctor was blaming water intake.