Why age is so important when doctors diagnose their patients

Telegraph

09-05-2025

It is a commonplace that the probability of different types of illness changes over time. The childhood infections of measles and chickenpox are rarely seen in adult life when, if they do occur, they are usually unaccountably severe. The many conditions that tend to manifest in middle age – multiple sclerosis or Type 2 diabetes – are quite different again from the 'chronic degenerative' afflictions of later life: cataracts, arthritis, prostate problems and so on.
This ranking of diagnostic probabilities by age is obviously useful in focussing doctors' attention on the most likely explanation for any particular symptom and arranging the necessary investigations that might confirm it. The problem, as can be imagined, is when people develop an illness inappropriate for their age group. This is a particular hazard for those in their 30s and 40s with some serious condition, heart disease or cancer, that more typically occurs in later life. Their chest pains are misinterpreted as being a result of heartburn or indigestion until suddenly, seemingly out of the blue, they have a heart attack at which point their true significance becomes clear.
Similarly a recent change in bowel habit, whether constipation or diarrhoea, of two or three weeks duration which in the older person is readily recognisable as a potentially sinister indicator of a bowel tumour may seem less alarming in the (relatively) young. But it should be for, as recently reported in this paper, the prevalence of early onset colorectal cancer (EORC), as it is known, has risen dramatically – particularly those in their 20s – over the past three decades. The reason for this disturbing trend remains unclear but indicates the need for prompt and thorough investigation of bowel symptoms at any age.
By contrast, the reverse of the situation may occur in the older age group where the attribution of symptoms to a 'chronic degenerative' disease is mistaken for one that is eminently treatable. Thus while breathlessness, wheezing and coughing in someone in their 60s or beyond is most likely caused by the damaged lungs of emphysema, it may in fact may be because of late onset asthma. The distinction is readily made by prescribing steroids at high dosage that not only markedly improves the breathlessness but also renders the airways more sensitive to bronchodilator drugs such as salbutamol that facilitate the passage of air in and out of the lungs.
Or again, those afflicted by pain and stiffness of the hips or knees may reasonably attribute this to 'wear and tear' arthritis of the joints only modestly alleviated by painkillers and anti-inflammatory drugs. They may however have the rheumatological condition elderly onset rheumatoid arthritis (EORA) that responds well to the potent drug methotrexate. While, as a general rule, the probability of diverse illnesses are indeed age determined, it is necessary to be aware that, as with all rules, this is not absolute.
The causes of fainting
People faint for many reasons. In quick succession the diameter of the major arteries dilates in size critically reducing the pressure pumping blood up to the brain – resulting in dizziness, sweating and 'blacking out'. Besides ensuring the victim is lying comfortably on the ground, the standard first aid procedure, as all know, is to elevate the legs countering the fall in pressure by increasing the volume of blood returning to the heart and thus available to be pumped up to the brain.
Italian physician Dr Bruno Simini suggests the same principle can be deployed as a preventive measure. Anyone feeling they are about to faint, should, he advises, raise their hands above their head. This will cause the blood in the arms to drain back to the heart in the same manner as elevating the legs and with the same beneficial effect. He claims this to be 'a simple manoeuvre, hitherto not reported' though a fellow physician recalls being taught it back in the 60s. Either way, certainly useful to know.