When a patient has made it to 85 years old in reasonable health, their instinct--and often their physician's--is to redouble prevention efforts, optimize every number and close every gap. I want to argue the opposite.

If you have made it to 85 and are healthy and living independently, you have won the game of life. The appropriate response is not more medicine. It is recognizing what got you there and being very careful not to break it. We have precious few interventions that can reliably extend an 85-year-old's lifespan (let alone their health span) but an infinite number of ways we can mess it up.

What winning the game actually means

Average life expectancy at birth in the United States is roughly 78 years. A healthy 85-year-old has outlived that mark by nearly a decade, and someone born in 1940, when life expectancy at birth was closer to 63 years, has outlived what the actuarial tables of their birth year would have predicted by more than two decades.

Something is working, likely their genetics and lifestyle behaviors, acting together with a huge dose of good fortune, none of which we fully understand. That humility should inform everything that follows. This is a patient who succeeded at survival--not one who failed prevention--and interventions calibrated for a 58-year-old in a randomized clinical trial do not apply to them in any straightforward way.

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