Healthy Aging at 70 and Beyond: The Evidence-Based Guide to the Later Decades
Much longevity advice is aimed at people in midlife. This guide is for adults in their 70s and beyond, where trials show real gains from strength training and fall prevention, and where medication review and age-specific treatment targets matter.
- It is never too late: in a trial of frail nursing-home residents aged 72 to 98, ten weeks of resistance training raised muscle strength by 113 percent, against 3 percent without exercise.1
- Strength predicts survival: in the PURE study, lower grip strength predicted death more strongly than systolic blood pressure.6
- Polypharmacy is common: the share of US adults 65 and older taking five or more prescription medicines tripled from 12.8% to 39.0% between 1988 and 2010.7
- Protein: an expert group recommends at least 1.0 to 1.2 g/kg of body weight a day for people over 65, 1.2 or more for those who are active, and 1.2 to 1.5 for those with acute or chronic disease.8 Older men needed more protein per meal than younger men to reach their maximal muscle-building response.9
- Falls: in trials of older people living in the community, exercise reduced the rate of falls by 23%.10
Longevity advice often assumes prevention must start decades before disease. Adults in their 70s and 80s have a different opportunity: keeping strength, function and independence, and the trials below show these can still improve.
Resistance Training in Older Adults
Muscle strength is a strong marker of health in later life: in the PURE study, lower grip strength predicted death more strongly than systolic blood pressure.6 And strength responds to training at any age: in frail nursing-home residents with a mean age of 87, ten weeks of progressive resistance training raised strength by 113 percent.1
A meta-analysis of resistance training in older adults found a positive effect on every strength measure it analyzed.2 US guidelines advise muscle strengthening on 2 or more days a week and, for older adults, balance training as part of a mix of activities.11 Protein supports training: the PROT-AGE group advises at least 1.2 g/kg a day for older adults who exercise.8
Polypharmacy
Among US adults 65 and older, the share taking five or more prescription medicines tripled from 12.8% in 1988 to 39.0% in 2010.7 Polypharmacy, using more medicines than are medically necessary, is a growing concern for older adults because of its negative consequences.3
Over the same period, use of potentially inappropriate medications fell from 28.2% to 15.1%.7 Lists such as the American Geriatrics Society's Beers Criteria name medicines worth reviewing; if you take several, ask your doctor or pharmacist for a medication review.
Cardiovascular Medicine in Older Adults: Age-Specific Calibration
In SPRINT participants aged 75 and older, aiming for a systolic blood pressure below 120 mm Hg instead of 140 lowered the rate of major cardiovascular events: 102 events against 148 over a median of 3.14 years.4 Decisions about other preventive medicines late in life are individual; discuss them with your clinician.
Vaccines Matter More With Age
Shingles. In a trial of 13,900 adults aged 70 or older (mean age 75.6), the recombinant shingles vaccine had 89.8% efficacy against shingles over a mean of 3.7 years: 23 cases among vaccinated participants against 223 with placebo.12 In a pooled analysis of people over 70 from two trials, it was 88.8% effective against postherpetic neuralgia, the lasting nerve pain that can follow shingles.12
Flu. In a trial of 31,989 adults aged 65 or older, a high-dose flu vaccine (60 micrograms of antigen per strain, against 15 in the standard vaccine) produced stronger antibody responses and better protection: laboratory-confirmed flu occurred in 1.4% of the high-dose group against 1.9% with the standard dose, across the 2011–2012 and 2012–2013 flu seasons.13 Ask your doctor or pharmacist which vaccines you are due for.
Hearing
Hearing loss is associated with faster cognitive decline and with dementia in older adults.14 The ACHIEVE trial tested whether treating it helps: 977 adults aged 70 to 84 with untreated hearing loss received either hearing aids with audiology counselling or health education.14 In the whole group, 3-year cognitive change did not differ significantly between the two arms; a prespecified analysis found that the effect differed between participants drawn from a long-running heart study, who were older, had more risk factors for cognitive decline and had lower baseline cognitive scores, and healthier volunteers.14
Staying Connected
Relationships are part of healthy aging. Across 148 studies with 308,849 participants, people with stronger social relationships had a 50% higher likelihood of survival (odds ratio 1.50), an effect the authors judged comparable with well-established risk factors for death.15
Cognitive Reserve: The Lifelong Investment That Pays Off in Old Age
Cognitive reserve describes differences in how people's brains cope with damage; epidemiological studies suggest education, work and leisure activities in later life can increase it, while brain reserve refers to structural differences that may increase tolerance to pathology.5
Put this research into practice: Build Your Longevity Protocol
References
- 1Fiatarone MA, et al. "Exercise training and nutritional supplementation for physical frailty in very elderly people." N Engl J Med. 1994;330(25):1769-75. PubMed · DOI
- 2Peterson MD, et al. "Resistance exercise for muscular strength in older adults: a meta-analysis." Ageing Res Rev. 2010;9(3):226-37. PubMed · DOI
- 3Maher RL, et al. "Clinical consequences of polypharmacy in elderly." Expert Opin Drug Saf. 2014;13(1):57-65. PubMed · DOI
- 4Williamson JD, et al. "Intensive vs Standard Blood Pressure Control and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years: A Randomized Clinical Trial." JAMA. 2016;315(24):2673-82. PubMed · DOI
- 5Stern Y. "Cognitive reserve in ageing and Alzheimer's disease." Lancet Neurol. 2012;11(11):1006-12. PubMed · DOI
- 6Leong DP, et al. "Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study." Lancet. 2015;386(9990):266-73. PubMed · DOI
- 7Charlesworth CJ, et al. "Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988-2010." J Gerontol A Biol Sci Med Sci. 2015;70(8):989-95. PubMed · DOI
- 8Bauer J, et al. "Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group." J Am Med Dir Assoc. 2013;14(8):542-59. PubMed · DOI
- 9Moore DR, et al. "Protein ingestion to stimulate myofibrillar protein synthesis requires greater relative protein intakes in healthy older versus younger men." J Gerontol A Biol Sci Med Sci. 2015;70(1):57-62. PubMed · DOI
- 10Sherrington C, et al. "Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review." Br J Sports Med. 2020;54(15):885-891. PubMed · DOI
- 11Piercy KL, et al. "The Physical Activity Guidelines for Americans." JAMA. 2018;320(19):2020-2028. PubMed · DOI
- 12Cunningham AL, et al. "Efficacy of the Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older." N Engl J Med. 2016;375(11):1019-32. PubMed · DOI
- 13DiazGranados CA, et al. "Efficacy of high-dose versus standard-dose influenza vaccine in older adults." N Engl J Med. 2014;371(7):635-45. PubMed · DOI
- 14Lin FR, et al. "Hearing intervention versus health education control to reduce cognitive decline in older adults with hearing loss in the USA (ACHIEVE): a multicentre, randomised controlled trial." Lancet. 2023;402(10404):786-797. PubMed · DOI
- 15Holt-Lunstad J, et al. "Social relationships and mortality risk: a meta-analytic review." PLoS Med. 2010;7(7):e1000316. PubMed · DOI
