HEALTH SECOND OPINION

HEALTH education is mostly concerned with the prevention of premature death, by which is meant death before the age of 60. Yet nearly half of us eventually reach the age of 80. The few research studies that have been done on people of this age have suggested that their health risks are different - as might be ex-pected. The very old are the lite winners of the biological competition for survival, and it is slowly becoming apparent that they need a different package of health tests and treatments if they are to be helped to live even longer.

The latest study of health risks in the elderly comes from Yale University. Blood cholesterol tests were carried out on 997 old people with an average age of 79 in 1988, and they were monitored for four years. One-third of those examined had raised levels of cholesterol in their blood, but no link was found between high levels and the numbers having heart attacks or the overall mortality of those studied. In this age range, having a high cholesterol level does not seem to predict a greater risk of heart disease. These findings are in line with other studies such as the Framingham project, which found that the risk of heart disease in those with raised cholesterol levels became smaller as they grew older and disappeared by the age of 80.

These findings are of more practical importance in the United States than in Britain: as many as two million Amer-icans aged over 65 are taking drug treatments to bring down their cholesterol levels, despite the lack of convincing evidence that this treatment will improve their health and some evidence that the treatment is associated with an increased risk of cancer.

What about the other advice that is given to the middle- aged? How much of it has been shown convincingly to apply to the elderly? Not much. For the young and middle-aged the lower the blood pressure the better the health expectation, but this relationship is less clear beyond 80. Someone of that age found to have a slightly raised blood pressure will not necessarily benefit from treatment. The Duchess of Windsor's comment that no one can be too thin (or too rich) certainly does not apply to the elderly: being thin goes with osteoporosis and an increased risk of fractures.

The important message emerging from this research is that health advice to the very old has to be based on research done on the very old. At present few studies have been done on the over-80s, so doctors and other health educators would be well advised to be cautious in telling people which activities are bad for them - and should be especially cautious about telling people of this age that they should take drug treatments of un- proved value. That applies not only to treatment with medical drugs; caution should be used in examining the claims made for vitamins, minerals, ginseng, honey or any other rejuvenator.