Table 1

 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