Better health in our 80s and 90s

Snapshot of the 80s and beyond

Despite the challenges, many people have a very good quality-of-life well into their later years – they remain healthy, physically robust and mentally sharp; they retain their mobility, vitality and feel good, sometimes great; they maintain independence and stay socially connected.

80s and 90s Topics …

• Preventing health problems and maintaining resilience
• Main predictors of ongoing health
• How to strengthen ongoing health
• Other factors for current and ongoing health
• Risks and early warning signs
• Screenings & check-ups
• Target heart rate when exercising
• Health records and directives
• What to do – today – to improve your health
• Checklist – proactive steps for the 80s
• Your proactive health plan
• Appendix A – Tests to predict future health
• Appendix B – Physical health issues
• Appendix C – Disease and illness risks
• Appendix D – Health Guidelines 65+

Preventing health problems and maintaining resilience

Preventing health problems

A lot of the literature about health in the 80s and beyond emphasises management rather than prevention. For some people this may be appropriate, but a positive mindset will still favour a proactive approach – the right diet; exercise; sleep; social connections and mental stimulation.

Maintaining resilience

Proactive health isn’t just about preventing health problems. It’s about how you feel every day – your energy, mobility, focus and mood. Continuing to build resilience in your 80s can still make a difference. The right steps will help you maintain mobility, protect your brain health, support your emotional well-being and preserve independence.

Predictors of ongoing health in our 80s

The following areas of health are strong predictors for people in their 80s of future health and quality-of-life. You may want to read a bit more about each of these areas further down the page or, alternatively, you can skip through to Appendix A that contains the tests that will enable you to know what your current state of health means for your ongoing health and the proactive steps that will protect it.

There is a preliminary self-assessment test which involves answering one simple question. If you score well, you may not want to do the other tests. If you don’t, the other tests are recommended. These are free, and can be done at home, except for the cardiometabolic tests (cholesterol, blood sugar etc) that need to be to be arranged with a doctor but can be bulk billed.

1. Strength, balance and mobility

Strength and balance in our 80s are the strongest predictors of continuing independence. They influence our ability to move safely, recover from illness, avoid falls and maintain confidence in daily activities. The good news is that strength and balance can still improve at this stage of life with the right approach: Physical activity.

2. Cognitive engagement and social connection

Staying mentally active is strongly linked to better brain health, emotional wellbeing and longevity. Neglecting this results in increased risk of cognitive decline and reduced independence: Cognitive engagement.

Ongoing social contact is also important for brain health, in addition to general well-being. Lack of social engagement at this stage of life typically produces loneliness which is not good for our future health or quality-of-life: Social connection.

3. Cardiometabolic

The goal is to have a stable blood pressure, blood sugar, cholesterol and hydration – significant fluctuations can mean dizziness, falls, confusion and slower recovery from illness. Stability means clearer thinking, better mobility and greater independence: Cardiometabolic.

You can still influence your ongoing health

What you do in your 80s still matters – a lot – for your ongoing health, independence, confidence and day‑to‑day enjoyment of life.

Good nutrition and social engagement are also important for preserving independence. And it’s essential to be vigilant about identifying early warning signs and diligent about regular health checks.

What should you focus on to improve your ongoing health?

For most people in their 80s, focusing on the three areas above will make the biggest difference in shaping their future health, wellbeing and quality of life. But they’re not the only ones that matter – diet and nutrition, stress management and sleep quality also play an important role. Each of these areas is explored below.

To understand what is best for you to focus on, the tests in Appendix A will give you an insight into your future health, and the proactive steps to strength it.

Key areas of health that matter most in our 80s

Physical activity

Maintaining light physical activity is essential for our well-being in our 80s, despite the aches and pains that we experience more often. Stretching remains important for balance and mobility, particularly joints and muscle groups that are the most important for walking and stability.

Strength and weight-bearing activities should be continued to counter muscle loss and strengthen bones – important in the event of a fall, especially for those people who have osteoporosis.

Mental activity and social connection

Cognitive engagement – having a purpose and ongoing learning

Social engagement

Cardiometabolic health

Cardiometabolic health refers to how well our cardiovascular system (heart and blood vessels) and metabolic system (how our body processes and uses energy) are functioning together. It’s shaped by factors such as blood pressure, cholesterol, blood sugar, body composition (muscle and fat), inflammation, and lifestyle behaviours like diet, exercise, sleep, and stress.

When all these factors are addressed, supplemented by regular checkups, the risk of problems such as heart disease, stroke and type 2 diabetes is lowered significantly.

Steps to improve cardiometabolic health

• Regular physical activity, both aerobic – cycling, swimming, brisk walking – and strengthening – whether weight-bearing (such as squats, lunges, step ups) or non-weight-bearing (such as machines, resistance bands, Pilates) – improve cardiometabolic health in a variety of ways if done regularly e.g. most days.
• A diet built around whole foods (vegetables, legumes, whole grains, lean proteins and healthy fats) helps stabilise blood sugar and reduces the metabolic strain caused by refined carbohydrates and sugary drinks.
• Limiting added sugars, highly processed foods and alcohol is important. Quitting smoking provides immediate and long‑term benefits for blood vessels and brain health.
• Maintaining a healthy waist circumference is particularly important, as excess visceral fat drives insulin resistance and inflammation (more information about this can be found in the resource section of the Guide here).
• Good sleep and stress management support metabolic balance.

Even modest improvements in these areas can help stabilise blood pressure, cholesterol and blood sugar, reduce inflammation and maintain insulin sensitivity.

High blood sugar and prediabetes

If your blood sugar is heading towards the prediabetic range, in addition to the steps taken above to improve cardiometabolic health in general, it can help to spread your carbohydrate intake more evenly across the day and avoid large, carbohydrate‑heavy meals that cause sharp glucose spikes. Periodic checks of fasting glucose or HbA1c can also provide useful feedback on how your lifestyle changes are working.

Other important areas for our 80s and ongoing health

In addition to the main predictors above, other factors are also necessary for good health in our 80s/90s and are also predictors of future health. Consistent sleep influences future health – your immunity, your metabolism and your brain. Diet and nutrition remain very important, and stress still needs to be managed, as explained below. Further reading: Health management for 70+

Diet and nutrition

In our 80s, diet still has a very important role to play, which means eating a wide variety of foods – not just fruits and vegetables, but also a variety of legumes, whole grains and nuts. And don’t forget the protein.

However, according to the Australian Institute of Health and Welfare, over 91% of Australians over 64 do not meet the recommended minimum consumption of fruit and vegetables so it’s a good idea to double check to make sure you are eating the right foods. But what are the “right” foods?

Supporting metabolism and muscle

By the 80s, metabolism slows further, and appetite may decline. The focus needs to be on nutrient density. Protein-rich foods (fish, eggs, lean meats, legumes, tofu) will preserve muscle mass; and vitamins (calcium and vitamin D) are needed to support bone health.

The right diet will support your metabolism and keep your blood pressure, cholesterol, blood sugar and weight within a healthy range.

Mediterranean-style eating

A Mediterranean style diet – vegetables, legumes, whole grains, olive oil, nuts and fish – remains one of the best‑supported diets for older adults. It helps reduce the risk of heart disease, diabetes, fatty liver, and cognitive decline while supporting longevity and quality of life. It’s also important keep processed foods and sugary drinks to a minimum.

There is a lot more information about the right diet, including foods that contain the necessary vitamins and nutrients, and weight management, in section 2 – Diet and nutrition.

Stress management in our 80s

Effective stress management includes regular social contact, time outdoors, gentle physical activity – regular walks, stretching, etc – social connection and meaningful activities – such as gardening and creative hobbies. Mindfulness or quiet reflection can also reduce anxiety and promote calm focus.

Risks, early warning signs and symptoms

However, many signs or symptoms are indeterminate and can point to different problems, so it is always wise to be sure by checking with your GP. Further reading: What’s normal and what’s not as we age

There is some supplementary information about these risks, and some others, in the appendices at the end of this section.

Health risk	Signs or symptoms	Notes
Arthritis	Pain, swelling and reduced range of motion can affect daily tasks	Both rheumatoid and osteo arthritis can appear for the first time in our 80s.
Cancer	Often no early warning signs	Routine screening (bowel, breast, prostate) usually stops in the late 70s. Cancer risk persists, but detection relies on symptoms rather than screening.
Cognitive decline	Forgetfulness gets worse and memory can show signs of impairment. Difficulty with words increases.	While some cognitive slowing is normal with age, the risk of more significant decline, including mild cognitive impairment, rises sharply in the 80s. Brain regions involved in memory and learning shrink, and blood flow decreases.
Depression	Low mood (including irritability), energy and motivation; poor sleep; withdrawal from social interactions	Loss of loved ones, reduced mobility and loneliness may call for mental health support. Social support and community engagement are important.
Diabetes: Type 2	Being overweight and lack of exercise are early warning signs although often there are often no signs	The risk remains high and is often undiagnosed because the signs can be mistaken for normal ageing. Screening is recommended – blood glucose and kidney function – especially for those with risk factors like hypertension, obesity, or family history.
Dementia	Severe memory loss, disorientation, difficulty recognising people/places	Dementia prevalence rises steeply in the 80s and 90s. Supportive care, routine and caregiver involvement become central.
Falls and fractures	Deterioration in balance and mobility	Hip fractures and hospitalisations rise sharply; osteoporosis exacerbates the danger. Prevention focuses on balance training, home safety, and vitamin D/calcium support.
Frailty & functional decline	General weakness, slower walking, reduced grip strength, difficulty with daily tasks	Frailty becomes a defining risk in the 80s and beyond. It increases vulnerability to falls, hospitalisation, and loss of independence.
Hearing decline	Difficulty picking up words especially in a noisy environment	Hearing problems can contribute to cognitive decline so they should not be ignored
Heart disease, high blood pressure and stroke	Being overweight and breathlessness after mild physical activity are possible indicators but there are not always any pre-warning signs	The risk remains high. Heart disease remains a major cause of death into our 80s. Arrhythmias and heart failure are far more common. Blood testing (cholesterol and blood sugar) and blood pressure should be checked.
Infections and sepsis	Confusion, fever, rapid decline	Older adults are highly vulnerable to urinary tract infections, pneumonia, and sepsis. Even minor infections can cause hospitalisation.
Pancreatic cancer	Usually no early warning signs; symptoms include obesity, type 2 diabetes, smoking and family history of cancer	This risk increases significantly and is one of the more serious health threats in the 80s with a high mortality rate. There is no general screening although people at high risk (family history or relevant mutation) may warrant specialised screening
Respiratory infections	Laboured breathing; shortness of breath; wheezing	Pneumonia, influenza, and COVID-19 are especially dangerous. Vaccination and early treatment are vital.
Vision problems	Cataracts – deterioration in vision clarity; glaucoma – no early warning signs	Increased risk needs to be managed by regular checkups

Further reading: Health risk factors for older Australians

Screenings & check-ups in our 80s and 90s

Test or checkup	Recommendation
Bone health and falls	Forewarning of the degree of risk (by undergoing fall testing and bone density testing) can be helpful
Cancer	Regular skin cancer testing remains advisable; other cancer testing depends on various factors that you need to discuss with your GP
Cardiovascular health	Ongoing blood tests (for cholesterol, blood sugar, etc) and blood pressure checks are helpful for providing information, especially if there are no early warning signs
Diabetes & kidneys	Blood glucose and kidney function tests are recommended for people over 60, especially those with risk factors like hypertension, obesity or family history
General health	Periodic GP visits are recommended for a broad review
Mental health	Screening may be advisable if symptoms warrant
Vaccinations	Shingles and pneumococcal. Regular flu and Covid 19
Vision & hearing	Biannual checks to support safety, mobility and social engagement

Please keep in mind that it may be advisable to get screenings done more regularly if there is either personal or family history of a health issue or relevant symptoms. Section 8.2 – Conditions that require screening – has a long list of available tests.

Target heart rates for exercising

Your target heart rate will depend on your objective, your age and your level of fitness. The first step is to work out your maximum heart rate (MHR) for exercising which can be calculated by subtracting your age from 220. Therefore, if you are 80, your MHR is 140 bpm (beats per minute) although this can vary depending upon level of fitness and state of health, etc. If your goal is gentle walking, the rule of thumb is to aim for 50-60% of MHR i.e. a heartbeat between 70 and 84 bpm. Before embarking upon anything above zone 2, it is wise to consult your doctor.

Goal	Zone	BPM age 80	Activity examples
Light exercise or recovery	Zone 1 (50–60%)	70-84	Gentle walking, yoga, light stretching
Aerobic / Fat burning	Zone 2 (60–70%)	84-98	Brisk walking, steady swimming, light cycling
Cardiovascular endurance	Zone 3 (70–80%)	98-112	Jogging, moderate cycling, swim intervals

Health records & directives

Health records: If you are injured or suddenly fall ill away from home, and need to be treated urgently, your medical records could be critical to the outcome of your treatment. That’s why it’s important to ensure they are accessible online. Talk to your doctor about this: see section 6.11 – Important Health Documents

Why a Will is not enough: If you are in an accident or become very ill, perhaps incapacitated, or even in a coma, who will pay your bills, arrange banking and otherwise manage your affairs?

What to do – today – to improve your health

1. Make a commitment to become more proactive and tell someone close to you about your decision, what you are going to do and when.

2. Check those areas of your current health that are predictors of ongoing quality-of-life to decide what areas you may need to focus on.

3. Make a list of proactive steps you are going to take and when you are going to start on each one.

Below is a brief checklist, and a template for a proactive plan that should be adapted by you for your specific circumstances, level of fitness and state of health. The more you cross-reference the various links in this section about the 80s and 90s to different parts of the Proactive Health Guide, the better your personal plan will be.

Checklist – proactive health for the 80s

• Keep moving – daily – even light activity protects mobility and confidence
• Weight-bearing exercise is essential (e.g. resistance bands)
• Practise balancing to prevent falls (tai chi, single‑leg stands, heel‑to‑toe walking)
• Review medications and supplements for side effects and interactions
• Monitor bone density and fracture risk; address issues early
• Eat enough protein to maintain muscle (often overlooked in this decade)
• Stay hydrated – thirst cues weaken significantly with age
• Protect skin – fragility increases; moisturising and gentle care help prevent tears
• Maintain regular medical checks (heart, eyes, hearing, dental)
• Keep the brain active with learning, creativity, conversation and problem‑solving
• Ideally, have a purpose – engage in purposeful pursuits
• Stay socially engaged to protect mental health
• Prioritise sleep routines to support mood, memory and energy
• Adapt the home environment for safety (lighting, rugs, handrails, clear pathways)
• Use mobility aids confidently – they prevent falls and preserve independence
• Seek support early for mobility, mood or significant memory changes.

Your proactive health plan

Making, and following, a proactive health plan can make a significant difference to your health. The more specific and detailed the plan is, the better. The plan needs to set out what areas of proactivity you intend to focus on and what you intend to do. There is a template set out below that needs to be adapted for your particular needs and current state of health. It should be quite detailed and specific. For example, instead of your list saying “Aim for 2 hours of moderate activity per week”, it is better to say something like “Walk 1.5 km at a brisk pace each Wednesday and Saturday morning”; instead of saying “Maintain a consistent sleep schedule” say “Go to bed at 10 PM and get up at 6:30 AM each day”.

You may want to do this on an Excel spreadsheet so that you can put in the starting date and have a column for each day of the month to keep track of how well you are progressing with your plan. Ideally, each day you will put a tick or a cross against each step that you have decided to embark on. Remember, consistency is the key – it is better to do a little bit every day, and continue doing it until it becomes a habit (see section 9 – Healthy people have better habits) than to do too much and burn out. That means – don’t set your sights too high when you start.

If you also want to track changes to various aspects of your health after embarking on your plan, have a look at section 10.2 – Track your progress

Proactivity focus	Details of what I am going to do	How often	Day 1
Deep breathing – see section 6.3 Breathing	I breathe deeply [in for 4 seconds; hold for 4; out for 4; and hold again for 4] and do it for 1-2 minutes whenever I need a deep breathing boost. The trigger to remind me to do this is … [e.g. when I start to lose concentration OR when I feel tense or under stress OR when I don’t feel happy, etc]	Multiple times throughout the day
Diet & nutrition – see section 2 Diet/Nutrition	I eat a wide variety of vegetables, fruits, legumes and whole grains by adding …. [state specifically what foods you are going to add to your diet]	Daily
	I limit sugar intake, processed foods and salt [be specific what you are going to reduce or eliminate from your diet]	Daily
	I boost my microbiome with probiotic and prebiotic foods [state the specific foods e.g. fermented foods – yoghurt, sauerkraut, etc]	Daily
Exercise – see section 3 Physical Activity	I do 30 minutes of … [e.g. brisk walking] twice per week before breakfast	Tuesday & Friday
	I swim for 30 minutes once per week	Saturday
	I do weights [or use resistance bands] to preserve muscle twice per week	Monday & Thursday
	I do balance exercises (e.g. tai chi, yoga) twice per week	Saturday Wednesday
	I play tennis [or golf, etc] once per week	Sunday
	I do a minimum of 10,000 steps every day	Daily
Medications	I check for interactions or side effects with GP or pharmacist if there are any changes in the way I feel and for any new drug	Insert date
Mental health	I stay mentally active by … (e.g. puzzles, reading) See section 4.2	Daily
	I learn … [e.g. about the 100 years war OR a new language OR a musical instrument]	Daily
	I work on brain health [specify what you are going to do] See cognitive training section 4.2	Insert when
	I work on being positive See section 5.2	Insert when
	I take part in a purposeful activity [ e.g. volunteering or a project such as renovating part of your garden] See section 4.2	Insert date
Mindfulness – see section 5.3 Mindfulness	I engage in mindfulness regularly during each day. The trigger to remind me to do this is … [when I daydream OR when I find my posture is poor OR when I lose concentration OR when I walk through a doorway OR … etc]	Multiple times per day
Screenings & check-ups	Blood test including PSA and blood sugar; Colonoscopy; Mammogram; Skin cancer check; Eye test; Bone density scan, etc	Insert dates (month and year) for each one
Sleep hygiene – see section 6.1 Sleep	I go to bed at 10pm and get up at 6:30am	Each day
	No screens 1 hour before bed	Each day
	Address snoring or sleep apnoea with GP	Insert date
Social connections	I join a community group or interest-based club [be specific about what and when]	Insert date
	I stay engaged with friends and family, or community groups [be specific about what you are going to do and when] See section 4.2	Weekly or monthly
Symptoms & early warning signs	I monitor changes to the way I feel and keep a written record of any signs that I think are unusual. See section 7.2	Ongoing
Vaccinations – see section 6.8 Vaccinations	I get an annual flu and pneumonia shot; I get a Covid 19 booster	Insert date for each one
Other	This is for other issues that may be important for you

APPENDIX A

What your future health has in store for you and how you can shape it in your 80s

This appendix gives you simple ways to find out what various aspects of your current health might be telling you about your quality-of-life in the years ahead. No need for special equipment or expensive testing – most checks can be done at home and are free. There are also suggestions about what proactive steps you can take based on your test results.

The encouraging news is that your body and brain remain responsive to targeted improvements in your 80s – especially in strength, balance, nutrition, sleep and social connection.

These predictive tests and suggestions are based on a synthesis of data from medical research and population studies – including the Harvard Study of Adult Development and the WHO Healthy Ageing Frameworks – and accordingly they should be used as general guidelines rather than personalised advice.

PRELIMINARY: SELF-ASSESSMENT TEST

This test comprises one simple question: how you rate your current health? Excellent? Very good? Good? Fair? Poor?

A rating of fair or poor predicts higher risk of falls, frailty, cognitive decline, hospitalisation and reduced independence. It also predicts reduced resilience after illness or injury. A rating of excellent, very good or good predicts stronger mobility, better cognitive outcomes, greater emotional wellbeing and a higher likelihood of maintaining independence. Even in the 80s, people with positive self‑rated health tend to live longer and recover better from setbacks.

This is clearly a subjective test and, although it is a reasonably good predictor of future physical, emotional and cognitive health, it is not as accurate as the objective tests that follow. It also does not identify what areas of your health may need attention or what proactive steps would be of the most benefit. It is therefore a good idea to do the cognitive ageing test and the other individual tests below.

COGNITIVE AGEING TEST

It’s important to know how well your brain is likely to age, especially because the earlier you take steps to offset the chance of accelerated cognitive ageing, the more effective it will be. The research is clear – even people who score badly on the tests below can still meaningfully change their cognitive future by taking the right steps.

The tests, and what the results mean, are based on work done by Professor Anstey at ANU.

How to score

Please choose the option for each cognitive ageing test (1-15) that best describes you over the past 12 months and then tally the results based on the following scoring: low risk = 0 points; moderate risk = 1 point; high risk = 2 points (except for questions 3 and 4 where the score for high risk = 3 points).

What your total score means

How to interpret your results is explained after the last cognitive ageing test below. In general, the lower your total score for all the tests combined, the slower your “cognitive ageing” is likely to be. This means a higher likelihood of:

• staying mentally sharp and capable;
• learning, and remembering, new things more easily;
• managing complex tasks more effectively;
• being more adaptable e.g. to change and switching tasks;
• retaining mental resilience against stress and illness;
• ageing better e.g. remaining independent; and
• enjoying a higher quality of life for longer.

SECTION A: LIFESTYLE FACTORS

Test 1. Physical activity

• Low risk – I do 150 minutes or more of moderate physical activity per week or a minimum of 75 minutes of vigorous physical activity.
• Moderate risk – I do 60-150 minutes or more of moderate physical activity per week or a minimum of 30-75 minutes of vigorous physical activity.
• High risk – I do less than 60 minutes of moderate physical activity per week or less than 30 minutes of vigorous physical activity.

Proactive steps

Suggestions about physical activity can be found below under the individual aerobic and strength tests. If you would like additional information, there is more detail in the Exercise section above and more again in the resource section of the Guide: http://proactivehealthguide.com.au/3-exercise/#3-Exercise.

Test 2. Diet quality

• Low risk – I have a very good diet. I eat a variety of fruit, vegetables and whole foods on a daily basis.
• Moderate risk – My diet is not as good as described for the green zone. I consume less variety and some processed foods.
• High risk – I frequently consume processed foods and do not consume a wide variety of fruit, vegetables or whole foods.

Proactive steps

Suggestions can be found in the Diet and nutrition section above. If you would like additional information, there is more detail in the resource section of the Guide: http://proactivehealthguide.com.au/2-diet-nutrition/#2-DietNutrition.

Test 3. Alcohol

• Low risk – I have 10 or less standard drinks per week with no binge drinking.
• Moderate risk – I have 11-20 standard drinks per week or occasional binge drinking [5 or more standard drinks].
• High risk – I have 20 or more standard drinks per week or I binge drink at least once per week.

Proactive steps

Self-evident: reduce consumption.

Test 4. Smoking

• Low risk – I have never smoked OR I used to smoke but I quit more than 20 years ago and only ever smoked likely i.e. less than 5 cigarettes per day.
• Moderate risk – I am a very light smoker (1-2 cigarettes per week) OR I used to smoke but quit 5-20 years ago
• High risk – I smoke every day OR I smoke at least several cigarettes per day on a regular basis.

Proactive steps

Self-evident: reduce or, preferably, stop.

Test 5. Cognitive engagement

• Low risk – I engage in regular cognitive activities e.g. reading, learning, puzzles or hobbies.
• Moderate risk – I engage in occasional cognitive activity.
• High risk – I rarely engage in cognitive activity.

Proactive steps

Suggestions can be found in the Cognitive engagement section above.

SECTION B – MEDICAL and PHYSICAL FACTORS

Test 6. Blood pressure

• Low risk – My BP is normally less than 130/80.
• Moderate risk – My BP is normally in the range 130-139/80-89.
• High risk – My BP is normally more than 140/90 OR I am on blood pressure medication.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 7. Diabetes or pre-diabetes

• Low risk – I am neither diabetic nor pre-diabetic.
• Moderate risk – I am pre-diabetic.
• High risk – I am diabetic.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 8. Cholesterol

• Low risk – My LDL cholesterol is normal (less than 2.6).
• Moderate risk – My LDL cholesterol is between 2.6 and 3.3.
• High risk – My LDL is over 3.3 OR I am on lipid medication.

Proactive steps

Suggestions can be found in the Cardiometabolic health section above.

Test 9. Hearing

• Low risk – I have no difficulty hearing.
• Moderate risk – I have mild difficulty hearing and do not wear hearing aids
• High risk – I have significant difficulty hearing and do not wear hearing aids.

Proactive steps

If in any doubt, get tested. The tests are usually free of charge.

Test 10. Head injury and loss of consciousness

• Low risk – I have never had a head injury when I have lost consciousness.
• Moderate risk – I have had one head injury when I lost consciousness.
• High risk – I have had multiple head injuries when I lost consciousness.

Proactive steps

Protecting your head from future injury is critically important – repeated impacts carry the greatest long-term risk. Because head injury interacts with other risk factors, keeping your cardiovascular and metabolic health in good shape – including blood pressure, cholesterol, glucose, weight and physical activity – provides strong protection for the brain. Staying mentally active, socially engaged and maintaining good sleep habits all help build cognitive reserve and support long‑term brain health.

If you notice ongoing symptoms such as headaches, memory problems or difficulty concentrating, it’s wise to discuss them with a health professional.

SECTION C – PSYCHOLOGICAL and SOCIAL FACTORS

Test 11. Mood

• Low risk – My mood is generally stable i.e. I feel positive or neutral most days. Any ups and downs pass quickly and do not affect my motivation, relationships or daily activities.
• Moderate risk – I occasionally suffer from low mood in the sense of feeling down or flat but it lasts no more than a day or two before I bounce back. It does not affect my ability to work, socialise or manage daily tasks.
• High risk – At times I feel depressed or in a low mood that lasts for two weeks or more. It reduces my motivation, energy and enjoyment of life and affects my ability to concentrate. It affects my work, relationships or daily tasks. It means I lose interest, avoid social contact and sometimes feel overwhelmed by routine responsibilities.

Proactive steps

Regular routines, consistent sleep, daily physical activity and staying socially connected all help stabilise mood and reduce the stress hormones that accelerate cognitive ageing. Engaging your mind through reading, learning, hobbies or creative activities also helps build cognitive reserve. Reducing alcohol, managing stress and spending time outdoors can also make a difference.

If low mood is persistent, worsening or affecting your daily life, seeking support from a qualified health professional is important.

Test 12. Social connection

• Low risk – I meet most of the following criteria for this risk group: I have ongoing relationships and  weekly contact with friends, family or groups in person, by phone or video; I have at least one person I can rely on for emotional or practical support; I participate in social, community or group activities at least monthly; I feel connected and not alone.
• Moderate risk – I meet most of the following criteria for this risk group: I have social contact with friends, family or groups in person, by phone or video at least once a month but they are not close or meaningful relationships; I have one person I can generally rely on for support but it feels limited or inconsistent; I sometimes feel alone or disconnected; I participate in social or community group activities occasionally but not on a regular basis.
• High risk – I meet most of the following criteria for this risk group: I have social contact with friends, family or groups in person, by phone or video less than once a month; I have no one I can generally rely on for support; I feel alone or disconnected much of the time; I lost my social network and have not rebuilt connections; I live alone and have very little social interaction.

Proactive steps

Suggestions can be found in the Social Engagement section above.

Test 13. Sleep

• Low risk – I have 7-9 hours of restorative sleep most nights.
• Moderate risk – My sleep is disrupted by stress or lifestyle factors OR I have difficulty falling asleep and/or staying asleep 1-2 nights per week.
• High risk – I regularly suffer from insomnia OR wake without feeling rested OR feel tired/sleepy most days OR I suspect I have sleep apnoea (snoring, gasping, pauses in breathing).

Proactive steps

Suggestions can be found in the resource section of the guide: Sleep.

SECTION D – COGNITIVE SELF-ASSESSMENT

Test 14. Memory

• Low risk – I forget things occasionally, but these lapses do not affect my daily tasks, and I am able to recall recent events, conversations and appointments with normal effort. My memory feels appropriate for my age.
• Moderate risk – I sometimes forget names, appointments or why I walked into a room, or I misplace items more often than I would like. These lapses are noticeable but not disruptive – they do not affect my day‑to‑day living, efficiency or reliability.
• High risk – I forget appointments or conversations regularly, or I repeat myself or ask the same questions without realising, or I often lose items or lose track of tasks, or I have difficulty following complex instructions. These lapses interfere with my day‑to‑day living, efficiency or reliability, and may be noticeable to others.

Proactive steps

Suggestions can be found under Cognitive engagement above and the links there to the resource section of the Guide.

Test 15. Attention/concentration

• Low risk – I can follow conversations, instructions and focus on tasks with normal effort.
• Moderate risk – I sometimes lose focus during long tasks and I occasionally need to re-read things but these lapses are intermittent and manageable.
• High risk – I have difficulty remaining focused even for short tasks and I frequently make mistakes due to inattention. These lapses interfere with my day-to-day life.  

Proactive steps

Suggestions can be found under Cognitive engagement above and the links there to the resource section of the Guide.

INTERPRETATION OF RESULTS

Low risk: 0-10 points

Your lifestyle and health profile indicate healthy cognitive ageing. Maintain your healthy habits but continue to monitor risk factors i.e. those areas where you did not score well.

Moderate risk: 11-21 points

Your risk of faster cognitive ageing is increased. It’s never too late to modify the risk by taking steps to improve underperforming areas. Small changes now can significantly improve future cognitive health.

High risk: 22-32 points

You have many risk factors associated with faster cognitive ageing so it’s important to take steps as soon as possible to address underperforming areas.

AEROBIC CAPACITY

Aerobic capacity generally declines more rapidly in our 80s and is a strong predictor of long-term health including the risk of cardiovascular disease, future mobility, quality-of-life and even long-term brain health. You can do either the walking test (test 1) or test or the stair-climbing test (test 2), or both.

Test 1: Walk for 6 minutes

Walk briskly as far as possible in six minutes on a flat surface.

Outcome and what it predicts

• Green zone – being able to walk 500 metres or more without being overly puffed indicates good aerobic capacity for the 60s, lower long-term cardiovascular risk and slower biological ageing.
• Amber zone – 420-500 metres suggests below optimal aerobic fitness and higher risk of cardiovascular disease and reduced mobility in later decades.
• Red zone – less than 420 metres predicts a higher risk of heart disease and increased risk of frailty later decades.

Proactive steps

• Green zone – maintain at least 150 minutes of moderate activity per week including one long exercise session and one faster session per week
• Amber zone – aim for a brisk 30 minute walk five days per week and one 20 minute interval training session (1 minute fast; 1 minute easy)
• Red zone – aerobic activity needs to be increased starting with at least 10-15 minutes of brisk walking 4-5 days per week and gradually increase this until you reach 30 minutes. Your goal is to end up doing the activity recommended for the green zone.

Test 2: Stair climb – three flights

Time how long it takes to climb 3 flights at a steady pace.

Outcome and what it predicts

• Green zone – 70 seconds or less indicates good aerobic capacity and lower risk of future cardiovascular issues.
• Amber zone – 71-90 seconds suggests reduced aerobic capacity, higher future cardiovascular risk and reduced future mobility.
• Red zone – taking more than 90 seconds indicates significantly higher risk of future heart disease and reduced mobility.

Proactive steps

• Green zone – maintain regular light activity, preferably 150 minutes per week (e.g. walking). Ideally include one longer session (40-60 minutes) and one brisker session each week.
• Amber zone – aim for a brisk 30 minute walk 4-5days per week. Ideally, include one stairclimbing session.
• Red zone – start with at least 10-15 minutes of brisk walking 3-5 days per week and gradually increase this until you reach 30 minutes. Your goal is to end up doing the activity recommended for the green zone.

STRENGTH

It is recommended to do both the lower body (test 1) and the upper body (test 2), or both.

Test 1: Lower body: 30 seconds sit-to-stand

With arms crossed, stand up and sit down as many times as possible in 30 seconds from a standard chair seat (43-45 cm high).

Outcome and what it predicts

• Green zone – 8 or more times indicates good lower‑body strength; good predictor of mobility in later decades.
• Amber zone – 6-7 times indicates higher risk of mobility limitations in the years ahead.
• Red zone – 5 or less times indicates a more significant decline in strength which predicts a higher risk of mobility decline, falls and reduced independence.

Proactive steps

• Green zone – do, or keep doing, at least 2 lower body strength sessions (e.g. sit-to-stand) per week each comprising 2-3 sets with 8-12 repetitions per exercise.
• Amber zone – lower body strength sessions (e.g. sit-to-stand) should be added to your exercise program starting with 2 sets of 8 repetitions per exercise once per week and gradually increase the difficulty and the number of repetitions so you end up doing two sessions per week with each session comprising 2-3 sets of 12 repetitions.
• Red zone – follow the suggestions for the Amber zone but start with exercises that are not as difficult (e.g. using a higher chair); increase the frequency and difficulty gradually until you get to the level suggested for the green zone.

Test 2: Upper body: 1 minute of inclined push-ups

Place your hands on the edge of a kitchen bench or sturdy table, no wider than shoulder‑width. Walk your feet back until your body forms a 45° angle to the floor. Keep your body in a straight line from shoulders to heels. Then bend your elbows – keeping them angled back not flared out – and lower your chest stopping when your upper and lower arm form roughly a 90° angle. This should mean your chest is 10-15 cm from the edge. Then straighten your arms fully. This constitutes one full push-up.

Outcome and what it predicts

• Green zone – 6 or more incline push-ups for men, and 4 or more for women, in one minute indicates good upper‑body strength for the 80s, a lower risk of shoulder or neck issues.
• Amber zone – 3-5 times for men, and 2-3 for women, in one minute indicates higher risk of mobility limitations in the future.
• Red zone – 2 or less times for men, and 1 or less for women, indicates a more significant decline in strength which predicts a higher risk of mobility decline, falls and reduced independence.

Proactive steps

• Green zone – do, or keep doing, at least 2 upper body strength sessions (e.g. incline push-ups, resistance bands) per week each comprising 2-3 sets with 8-12 repetitions per exercise.
• Amber zone – upper body strength sessions (e.g. incline push-ups, resistance bands) should be added to your exercise program starting with 2 sets of 8 repetitions per exercise once per week and gradually increase the difficulty and the number of repetitions so you end up doing two sessions per week with each session comprising 3 sets of 12 repetitions.
• Red zone – follow the suggestions for the Amber zone but start with exercises that are not as difficult (e.g. wall push-ups); increase the frequency and difficulty gradually over a period of a few months until you get to the level suggested for the amber zone and a few months later for the green zone.

CARDIOMETABOLIC HEALTH

Blood pressure; cholesterol; triglycerides; and blood sugar tests need to be arranged with your doctor and can usually be bulk billed. The proactive steps listed after Test 4 apply also to tests 1, 2 and 3.

Test 1: Blood pressure

Outcome and what it predicts

• Green zone – 130/80 or less indicates a lower long-term risk of heart attack, stroke and kidney disease.
• Amber zone – 130-139 systolic or 80-89 diastolic (e.g. 135/85) indicates a higher chance of developing hypertension and higher cardiovascular risk.
• Red zone – 140/90 or higher predicts a higher risk of heart attack, stroke and kidney disease and a higher likelihood of needing medical treatment.

Test 2: Cholesterol

Bad cholesterol (LDL) and what it predicts

• Green zone – less than 2.6 predicts a lower chance of cholesterol building up on the artery walls and lower long-term risk of heart attack or stroke.
• Amber zone – 2.6-3.3 indicates an increased likelihood of plaque build‑up and a higher chance of developing cardiovascular disease starting in the 60s.
• Red zone – above 3.3 indicates a stronger likelihood of plaque formation and higher long‑term risk of heart attack and stroke. In our 60s, this level is a strong signal that proactive steps are needed.

Good cholesterol (HDL) and what it predicts

• Green zone – more than 1.0 for men 1.2 for women indicates better natural protection against cholesterol build‑up and lower cardiovascular risk..
• Amber zone – 0.9-1.0 indicates reduced protective effect and a higher chance of cholesterol accumulating in arteries.
• Red zone – less than 0.9 indicates little natural protection and higher long‑term risk of cardiovascular disease. Low HDL is an important warning sign and should not be ignored.

Test 3: Triglycerides

What they predict

• Green zone – less than 1.7 indicates a healthy metabolism and lower risk of artery inflammation. In our 50s indicates better long-term cardiovascular health.
• Amber zone – 1.7-2.2 indicates a higher chance of cholesterol accumulating in arteries and therefore increased cardiovascular risk in the coming decade.
• Red zone – 2.3 and above indicates higher risk of heart disease, stroke and diabetes.

Test 4: Blood sugar

The following relates to HbA1c – a measurement of blood sugar averaged over the last 2-3 months. It is a better predictor of long-term health than fasting glucose level which is a snapshot of the sugar level at the time of the test.

What it predicts

• Green zone – less than 5.7% indicates lower risk of developing insulin resistance or type 2 diabetes.
• Amber zone – 5.7-6.4% indicates higher chance of developing type 2 diabetes in your 60s.
• Red zone – 6.5% and above indicates a higher risk of cardiovascular disease including diabetes. This level in the 50s indicates that proactive steps should be taken.

Proactive steps for blood pressure, cholesterol, triglycerides and blood sugar

• Green zone – maintain a healthy lifestyle including regular physical activity (at least 150 minutes per week walking, cycling, swimming, or similar); 2 strength sessions per week for upper and lower body; a balanced diet with a variety of fruits and vegetables; and a consistent sleep routine.
• Amber zone – the goal is to have a healthy lifestyle as described for the green zone including the adoption of a Mediterranean style diet; increasing fibre; reducing salt and processed foods. Also, if overweight, the goal should be a 5-10% weight reduction.
• Red zone – in addition to the recommendations for the amber zone, it is wise to consider medical advice relating to diet and possible medication.

STRESS and EMOTIONAL REGULATION

Test 1: Sleep

Sleep is a strong predictor of long-term physical, emotional and cognitive health. The simple test involves calculating how many nights per week you: fall asleep within 30 minutes; stay asleep without long waking periods; and wake up feeling reasonably restored?

Outcome and what it predicts

• Green zone – 5-7 nights per week indicates a well‑regulated stress system and emotional stability, lower risk of depression/anxiety, better cognitive ageing and lower risk of long-term cardiovascular disease.
• Amber zone – 3-4 nights per week indicates a higher chance of developing chronic stress and sleep problems, increased risk of weight gain and reduced emotional resilience, including irritability, in the next decade.
• Red zone – 2 or less nights per week indicates higher long-term risk of depression/anxiety, higher risk of a weaker metabolism (including diabetes), increased cardiovascular risk and faster cognitive ageing. It is a strong warning sign that should not be ignored.

Proactive steps

• Green zone – maintain a consistent sleep schedule and avoid bad habits that sometimes creep up such as phone or TV screens close to bedtime, late coffee, etc.
• Amber zone – advisable to adjust sleep habits, including consistent bed and wake times, limit caffeine after midday, reduce screen time 30-60 minutes before bed – [link to sleep]; increase physical activity (1-2 extra sessions of light to moderate activity per week) and reduce alcohol intake (even small reductions help) (e.g. 20 minutes walking per day).
• Red zone – sleep hygiene needs to be given priority – [link]; add the following to your daily routine: relaxation practices; more physical activity; and stress management. Consider professional sleep therapy advice if poor sleep persists, especially if it affects mood, energy or daily function.

Test 2: Resting heart rate

Your BPM (beats per minute) can be tested by counting your pulse to determine how many mornings per week your resting heart rate in the healthy range for your age – measure it first thing in the morning, before getting out of bed. It will give you an indication of your levels of stress and cardiovascular issues.

Outcome and what it predicts

• Green zone – 62-78 bpm 5-7 mornings per week indicates lower long-term cardiovascular risk; better stress resilience; low risk of developing high blood pressure; and better cognitive and emotional stability.
• Amber zone – 79-88 bpm 3-4 mornings per week indicates a higher chance of developing hypertension and increased cardiovascular risk (unless reduced).
• Red zone – above 89 or below 60 bpm on 3 or more mornings per week indicates an even a higher risk of heart disease and stroke; and greater risk of fatigue.

Proactive steps

• Green zone–maintain a healthy lifestyle including regular physical activity, consistent sleep habits and stress management routines (breathing, stretching and time outdoors).
• Amber zone – consistent sleep (bed and wake-up times); increase moderate physical activity (e.g. walking); reduce alcohol intake (even small reductions help); stress management (breathing, stretching and time outdoors).
• Red zone – increase exercise and manage stress (see Amber zone); give priority to sleep quality; reduce alcohol and caffeine; consider discussing persistent high RHR with a GP.

Test 3: Perceived stress

This test involves a self-assessment of your stress level by applying a score of 0-2 to each of the following statements. You need to rate how often each statement has been true over the previous two weeks. A score of 0 = never; 1 = sometimes; and 2 = often. Then add up the total of all five items:

1. I’ve felt overloaded or under pressure.
2. I’ve found it hard to switch off mentally.
3. I’ve felt tense, wound‑up, or on edge.
4. I’ve felt that small things have irritated me more than usual.
5. I’ve felt tired in a way that rest didn’t fully fix.

Outcome and what it predicts

• Green zone – a score between 0 and 3 on one or less days per week means you’re managing stress well – good for emotional stability and brain health.
• Amber zone – a score of between 4 and 6 means on 2-3 days per week indicates you’re carrying a moderate stress load – reduced resilience and higher fatigue.
• Red zone – a score of between 7 and 10 on 4-7 days per week means your stress level is high and indicates a high risk of mood and sleep problems, and reduced wellbeing.

Proactive steps

• Green zone – maintain routines that support calmness (walking, nature, hobbies); maintain habits that keep stress low such a simple daily pauses and deep breathing.
• Amber zone – identify one or two sources of stress you can reduce; add daily relaxation practices; increase light physical activity; improve sleep consistency and strengthen social connections.
• Red zone – give priority to rest, sleep, and recovery; add structured daily relaxation (breathing, guided relaxation, stretching); increase physical activity (such as walking).

APPENDIX B

Physical health issues in our 80s and 90s

• Arthritis: Almost half of Australians aged 75+ live with arthritis, which has a significant impact on mobility, balance and independence. Symptoms may include persistent joint pain, visible swelling and difficulty with stairs or grip strength. Treatment can include tailored exercise programs including strengthening muscles to support joints, and medications like NSAIDs or corticosteroid injections: see section 8.6 – Arthritis.
• Bone health: Maintain calcium (1,200 mg/day) and vitamin D (800–1,000 units/day).
• Cardiovascular: It is helpful to maintain regular aerobic and strength-based exercise (see section 3 – Physical activity) and to monitor blood pressure, cholesterol, and blood sugar annually (section 8.3 Heart disease and 8.4 High blood pressure). See also disease and illness risks below.
• Cognitive changes: Forgetfulness may increase; learning new information becomes harder, partly because of deteriorating connections between the neurons.
• Diet, nutrition and hydration: Focus on nutrient-rich foods, fibre, lean protein and healthy fats. Aim for 6-8 cups per day of fluids: see section 2 – Diet and nutrition.
• Eyesight: testing should be continued for cataracts and glaucoma.
• Falls and fractures: the incidence of falls and fractures increases because of deteriorating balance which makes it important to continue balance exercises; the consequences are more severe if osteoporosis is present
• Hearing: age-related hearing loss continues and needs to be checked – it can exacerbate cognitive decline.
• Mobility and muscular health: Prioritize gentle movement – walking, stretching and balancing exercises – to maintain flexibility and muscle tone. It is also good to do exercises to strengthen your core and stomach muscles to support posture and prevent back pain. Resistance bands will help to offset muscle loss.
• Osteoarthritis: See Arthritis above
• Osteoporosis: See Bone Health above
• Physical activity: Essential for good health to support vitality and resilience: see section 3 Physical activity. However, pain, stiffness and reduced mobility become more common in which case you may want to try a form of exercise that is gentler on your joints such as water aerobics or tai chi.
• Respiratory: Breathing problems, such as chronic bronchitis and emphysema, become more common, and can affect sleep and even lead to fatigue and infections. Asthma may also worsen due to reduced lung elasticity. If breathlessness starts to affect daily activities, it’s important to be test. It is also important to have flu and pneumococcal vaccination is to reduce complications.
• Sleep quality: If ongoing tiredness, consider a sleep assessment to rule out apnoea or other disruptions (see section 6.1 – Sleep). If you feel more than tiredness, and it persists for more than 2 weeks, talk to your GP – it could be fatigue.

APPENDIX C

Disease & illness risks in our 80s and 90s

• Cancer: Different types are listed in the table in section 8.2 Conditions that require screening
• Diabetes (Type 2): Risk remains high so annual tests for blood sugar and kidney function are recommended, particularly if you have a family history, if you start putting on weight or do not do regular exercise.
• Dementia: 1 in 3 people over 85 can be affected by severe cognitive decline
• Depression: Loss of loved ones, reduced mobility and loneliness may call for mental health support
• Heart disease: Heart problems (see section 8.3 – Heart disease) are a major cause of death during the 80s. Blood testing (cholesterol and blood sugar) and blood pressure should be checked, particularly if you have any increased risk factors, such as family history or lifestyle (overweight, sedentary, etc) or symptoms, such as breathlessness or swelling. It is also wise to check for plaque build-up in your arteries – ask your GP about a calcium score to gauge whether there are any blockages that can be present even when cholesterol is within the acceptable range. Your risk will be reduced if you maintain a healthy weight; avoid processed foods, smoking and excess alcohol.
• Medication safety: Some people need to take multiple medications at the same time. This increases the risk of side effects and adverse interactions between drugs so, if they are prescribed by different doctors, it’s very important for your GP or pharmacist to review your medications periodically.
• Mental health: Loneliness, grief and cognitive changes may need to be addressed including the risk of depression, anxiety and dementia. It’s important to continue with social connections and purposeful activities which regulate stress hormones. If you notice any cognitive impairment or mood swings, it’s a good idea to talk to your GP about screening. Consideration should be given to advanced care planning if this has not already been done [see Health Records and Directives above].
• Osteoporosis becomes more common. Bone density scans may be warranted. Management includes calcium, vitamin D, weight-bearing exercise and sometimes medication.
• Pelvic, urinary and sexual health: Urinary incontinence, pelvic organ prolapse and sexual health concerns may become relevant. It may also become advisable to review continence aids and pelvic floor support; consider topical hormone therapies; address sexual wellbeing, relationship and intimacy needs.
• Stroke: Stroke occurs when blood flow to the brain is interrupted, either by a blockage or a bleed. As a test of whether someone has had a stroke, remember the acronym: F.A.S.T.  Face (drooping), Arm (weakness), Speech (difficulty), and Time (to call emergency services – fast!). Other symptoms may include sudden confusion, vision changes, dizziness or severe headache. The risk of having a stroke is highest in our 80s. To reduce risk, regular health checks are essential – particularly for blood pressure, cholesterol and heart rhythm. Lifestyle changes such as quitting smoking, maintaining a healthy weight, staying active and managing chronic conditions like diabetes can dramatically lower stroke risk. If atrial fibrillation (irregular heartbeat) is present, medical management is crucial to prevent clot formation. Over 80% of strokes are preventable with proactive care.
• Thyroid: Thyroid hormones regulate metabolism, so imbalances can lead to symptoms like fatigue, weight changes, mood shifts and temperature sensitivity. The risk of a thyroid disorder increases in our 60s and can be detected by a blood test. Consistent treatment means people can live normal lives but, untreated, it can lead to complications such as heart failure, stroke, infertility or severe depression.

APPENDIX D

Physical activity guidelines (65 and older)

Guidelines have been issued by the Australian Department of Health, Disability and Ageing: https://www.health.gov.au/topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians/for-older-australians-65-years-and-over

Appendix D – Health Guidelines 65+