Cancer
Cancer can strike at any age, but the older we get, the more likely it becomes. “The two most common cancers of old age are breast and prostate cancers,” says Dr Richard Siow, the director of Ageing Research at King’s College London. “As we age, our cellular mechanisms reduce the clearance of damage within our cells.”
The older we are, the more we suffer from a process called “oxidative stress,” where chemicals called “free radicals” cause damage to organs and tissues.
“We all have genes that we are born with, and these are switched on and off at different points during our life: this is called epigenetics,” says Siow. “As our cellular mechanisms fail, this has an impact on our epigenetic predisposition.” In other words, our genetic flaws are more likely to mean we progress to disease.
What can we do about it?
An unlucky few people are born with genetic conditions which vastly raise their risk of certain cancers: for example, the BRCA-gene mutation which can lead to breast, ovarian and prostate cancer. “However, in many other cases, the main causes are in our lifestyles and mindsets,” says Sir Christopher.
Dr Siow agrees. “We can mitigate our risk with lifestyle interventions,” he says. “For example, to cut the risk of lung cancer, stop smoking, vaping and avoid exposure to air pollutants.”
After smoking, obesity is the second biggest risk factor for cancer. The risk increases in line with how overweight you are, and for how long. Research indicates that about 20 per cent of cancers are caused by excess weight.
Cutting back on alcohol and eating fewer ultra-processed foods (more on which below) serve significantly to reduce the risk of cancer, as does attending screening programmes for cervical, breast and bowel cancer.
Heart disease
Age affects our cardiac health in various ways. “Our blood vessels become blocked by various fats and lipids, and they can harden: they don’t relax and expand as they used to and this drives up blood pressure,” says Dr Siow. “Our blood is thicker and more prone to clotting, and the heart itself contracts less.”
There is some cause for optimism. As regards heart disease at least, our health is improving. In marked contrast to the other Horsemen listed here, deaths from cardiovascular illnesses have actually been falling since the 1970s.
“We are now increasingly surviving heart attacks,” says Dr Siow. “Medical procedures such as bypasses and stents are hugely influential, as is the wide prescription of statins to keep cholesterol under control. The decline of smoking has also had a lot to do with improving cardiac health.”
What can we do about it?
Despite the good news above, heart disease remains the world’s largest killer, responsible for 17.9 million deaths each year.
“The main message is not to wait for something to happen in your 50s and 60s before addressing your heart health,” says Dr Siow. “Make sure you drink less alcohol, become more physically active. You don’t have to be an Olympian: use the stairs, go out into open spaces: walking a hundred metres or one metre is better than no metres at all.”
Diet is also key. There has long been evidence of the cardiac health benefits of the Mediterranean diet: rich in lean meats, fruit and vegetables, olive oil, and pulses, as well as an avoidance of foods high in saturated fat, sugar and salt.
Stress can also be a factor, according to Ruth Goss from British Heart Foundation. “Stress on its own will not cause heart disease, but it can lead to unhealthy behaviours such as comfort food, smoking and drinking too much,” she says.
It’s also vital to manage conditions which can lead to heart attacks and strokes: cholesterol, high blood pressure, and diabetes: so make sure you attend your routine GP appointments.
Diabetes and other metabolic disorders
Type 2 diabetes (the type most often acquired later in life) may sound benign, but that is far from the truth. “Type 2 diabetes is characterised by a high rate of vascular complications and subsequent disability, frequent hospital admissions, and increased institutionalisation,” says the charity Diabetes UK.
People with poorly treated Type 2 diabetes can go on to suffer serious problems with their vision, kidney functions and even the loss of limbs.
Type 2 diabetes is the most common metabolic heart condition in older people. New figures from the charity show that 4.3 million people are now living with a diagnosis of diabetes in the UK (90 per cent of these being Type 2) and that 2.4 million people are at high risk of developing Type 2 diabetes in the UK.
Sir Christopher calls this condition “‘diabesity’, and, indeed, Type 2 diabetes is largely linked to physical inactivity, poor diet and weight gain. Particularly worrying is the news that obesity rates almost doubled in England between 1993 and 2019.
“Diabetes is a problem on its own but it also can also lead to conditions such as heart disease and dementia,” says Dr Siow.