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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 August 25; 335(7616): 361–362.
PMCID: PMC1952485
Prevention in Elderly People

Later life's complexity needs a scalpel rather than an axe

Desmond O'Neill, associate professor, medical gerontology

The key features of ageing are increased inter-individual variability, complexity, and comorbidity, which is why indicators of quality of care based on single disease models work less well among older than younger people. However, it is a far cry from this position to the nihilism of Mangin et al.1

Individualised health promotion for older people is highly effective2 and is likely to be among the reasons for falling disability among older Americans,3 to the point of stabilising healthcare expenditure on older people. Health promotion among older people embraces a far wider repertoire of manoeuvres than the prescription of statins, and sadly, evidence is abundant that old age is associated with a failure of doctors to provide health promotion to older people in a range of settings.4 5

Rather than systematically withholding preventive options for older people, clinicians should capitalise on other hallmarks of later life, wisdom and common sense, to develop a partnership approach whereby older people can choose whether or not to take up the different elements of an individualised health promotion programme. Using these gerontological principles effectively will help to ensure that health promotion in later life is sculpted with a scalpel rather than an axe.


Competing interests: None declared.


1. Mangin D, Sweeney K, Heath I. Preventive health care in elderly people needs rethinking. BMJ 2007;335:285-7. (11 August.) [PMC free article] [PubMed]
2. LIFE Study Investigators, Pahor M, Blair SN, Espeland M, Fielding R, Gill TM, et al. Effects of a physical activity intervention on measures of physical performance: Results of the lifestyle interventions and independence for Elders Pilot (LIFE-P) study. J Gerontol A Biol Sci Med Sci 2006;61:1157-65. [PubMed]
3. Manton KG, Gu X, Lamb VL. Change in chronic disability from 1982 to 2004/2005 as measured by long-term changes in function and health in the U.S. elderly population. Proc Natl Acad Sci U S A 2006;103:18374-9. [PubMed]
4. Arber S, McKinlay J, Adams A, Marceau L, Link C, O'Donnell A. Influence of patient characteristics on doctors' questioning and lifestyle advice for coronary heart disease: a UK/US video experiment. Br J Gen Pract 2004;54:673-8. [PMC free article] [PubMed]
5. Maguire CP, Ryan J, Kelly A, O'Neill D, Coakley D, Walsh JB. Do patient age and medical condition influence medical advice to stop smoking? Age Ageing 2000;29:264-6. [PubMed]

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