Why the over 80s must be considered separately from younger subjects
| Major differences | 1. Physiological changes at the extremes of old age |
| Over time the very elderly tend to lose weight; their blood pressures and serum cholesterol fall | |
| 2. The epidemiology is different | |
| Overweight and hypertension is associated with a better than average survival | |
| 3. They may have dementia | |
| They may not wish to survive longer | |
| 4. They are more often women | |
| When extrapolating the results of randomised trials, the results in women are most appropriate | |
| Minor differences | 1. Drug handling |
| Renal impairment, volume of distribution, etc—start with low doses of drugs and increase slowly | |
| 2. Lifestyle more fixed | |
| Possibly they may need more persuasion to change | |
| 3. Strategies for long term gain (10 years hence) are less appropriate | |
| For example, tight blood sugar control to prevent microvascular disease | |
| 4. Co-morbidity | |
| Exercise regimens may be limited by arthritis | |
| 5. They are survivors | |
| For example, surviving male diabetics are unlikely to smoke or require insulin. We do not know if this should influence management |