More doctors are asking a question that might surprise you: Is this treatment actually helping my older patient or could it be doing more harm than good?
Recent research is shedding new light on three very common medical routines. For adults over 60, the math on risks versus benefits looks different than it did a generation ago. Here is what the science is now saying.
Those Rough Patches on Your Skin May Not Need Treatment
You may have had a doctor point to a reddened or rough patch on your face, scalp, or the back of your hand and say it needs to come off. These spots are called actinic keratoses, and they show up from years of sun exposure. They are extremely common, nearly 30% of traditional Medicare patients were diagnosed with one over a five-year period, according to one large study.
The usual response is to remove them, often with liquid nitrogen, a topical cream, or laser therapy. The worry is that they might turn cancerous. But dermatologist Allison Billi at the University of Michigan says the actual risk is very low. Citing a 2013 meta-analysis, she noted that for the average patient with no history of skin cancer, there is less than a 1-in-1,000 chance of the lesion progressing to cancer. In fact, many of these spots simply disappear on their own.
And the treatment is no small thing. Billi describes removal as “extremely painful, both during and after,” with the possibility of swelling, irritation, and lasting discoloration. On top of that, actinic keratoses tend to come back or be replaced by new ones, it is a chronic condition, she says.
Her suggestion: Instead of automatic removal, primary care doctors could monitor the lesions once a year, watching for warning signs like bleeding, pain, or rapid growth. In many cases, she says, removal simply is not necessary. She does recommend wearing sunscreen.
A Common Thyroid Medication Some Seniors May Be Able to Stop
Levothyroxine is one of the most prescribed drugs in the world. People take it when their thyroid gland does not produce enough thyroid hormone, a condition called hypothyroidism, which can cause weight gain, fatigue, dry skin and hair, and a general slowing down of the body.
Doctors also prescribe it for a milder, symptom-free version called subclinical hypothyroidism, which can sometimes progress to the full condition. Most patients stay on it for life. But does everyone need to?
Researchers at Leiden University Medical Center in the Netherlands found that in many older adults with subclinical hypothyroidism, hormone levels normalize on their own. A separate study found that levothyroxine had no effect on symptoms and showed no apparent benefit in older patients with the condition.
The drug also carries real risks, especially for older adults. It can interact with other medications, requires frequent lab tests and doctor visits, and in high doses can cause hyperthyroidism, which may lead to cardiac arrhythmias and bone loss. Patients also have to adjust their diets and meal schedules around it.
The Dutch research team developed a careful protocol to see whether some patients could stop taking the drug. They gradually reduced doses over 30 weeks, with regular lab testing and doctor consultations. After a year, one quarter of the 370 participants, all over age 60, had successfully discontinued levothyroxine while maintaining healthy thyroid function. Most of those who stopped had been on lower doses to begin with.
Endocrinologist Maria Papaleontiou at the University of Michigan, who wrote an editorial accompanying the study in JAMA, was clear: patients should not stop taking levothyroxine on their own. Any discontinuation requires a gradual taper with medical monitoring. Some patients will always need the drug. But, she said, it appears that “a select group of adults over 60 may not require this treatment lifelong.”
Colonoscopies After 75: When the Risks May Outweigh the Benefits
The U.S. Preventive Services Task Force already gives colon cancer screening a lukewarm rating after age 76, calling the benefit “small.” Yet a 2023 study found that nearly 60% of older patients with limited life expectancies — less than five years — were still being advised to get another colonoscopy.
A major new study looked at almost 92,000 Veterans Affairs patients over 75 who had already had a previous colonoscopy. About 28% of them had previously had an adenoma found and removed, a type of polyp that can, in a small fraction of cases, become cancerous. After 10 years, those with a prior adenoma were slightly more likely to develop colon cancer than those without one. But the numbers tell a striking story.
Just 0.5% of veterans with a previous adenoma died of colon cancer. Among those without a prior adenoma, the figure was 0.4%. The lead author of the study, gastroenterologist Samir Gupta at the University of California-San Diego, called it “a tiny difference.” Meanwhile, nearly half of all the veterans in the study died within the decade from other causes.
The procedure itself carries risks that grow with age. One study found that nearly 7% of patients over 75 had a hospitalization or emergency room visit within a month of a colonoscopy.
Steven Itzkowitz, a gastroenterologist at the Icahn School of Medicine at Mount Sinai, co-wrote an editorial alongside the study. He put it plainly: “Even if the procedure goes well, you’ll either find nothing or you’ll find something that’s not going to have real impact on your longevity.”
He recently told an 85-year-old patient who’s in good health but on blood thinners for cardiac stents that she could skip her next colonoscopy. According to Itzkowitz, she seemed pleased.
None of this means abandoning medical care. It means having honest conversations with your doctor about what is actually worth doing at your age and in your particular health situation. The goal, as one researcher put it, is not to do everything that can be done but to do what genuinely helps.