What's a Healthy Result on a Medical Test?

You’ve probably been told to “know your numbers”—get certain measures of well-being checked—and keep them within certain parameters. But what’s right for you now?

“When it comes to things like blood pressure and blood glucose levels, for example, there’s ­research to show that there’s wiggle room, while in other cases, such as hearing or waist circumference, the target numbers don’t change,” says William Dale, M.D., Ph.D., chair of supportive care medicine at the City of Hope National Medical Center in Duarte, Calif., and a spokesman for the American Geriatrics Society.

Here, what the evidence reveals about the healthiest numbers to shoot for, and how to maintain them over the years.

Blood Pressure

Guidelines from the American Heart Association and the American College of Cardiology (ACC) recommend that everyone—regardless of age—should aim for blood pressure below 130/80 mmHg. But that may be too restrictive for certain older adults.

“If you’re over 65 with ­comorbid diseases, like lung disease, type 2 diabetes, or dementia,” Dale says, “we’re concerned that pushing your blood pressure too low can lead to other dangers, like feeling light-headed and falling.”

What to do: For many older adults, levels below 150/90 should be fine; levels above that call for blood pressure meds, Dale says.

If you’re in very good health, you might want to aim for 130/80 or lower, says Steven Nissen, M.D., chairman of cardiology at the Cleveland Clinic. But instead of using medication to get to those numbers, first consider focusing on lifestyle changes, such as losing excess weight, following a healthy diet, keeping salt under 1,500 mg daily, and exercising a minimum of 90 minutes weekly.

A 2017 study in the Journal of the American College of Cardiology found that reducing sodium intake and following the DASH diet (rich in fruits, vegetables, and whole grains, with low-fat or fat-free dairy, fish, poultry, beans, seeds, and nuts) lowered blood pressure as much as medication. 

Cholesterol

Cholesterol levels often rise with age. But that’s not necessarily cause for concern. “There is no holy grail for older adults, especially when it comes to ‘total’ cholesterol,” says Doug DeLong, M.D., chair of the board of regents at the American College of Physicians (ACP) and chief of the division of general internal medicine at Bassett Healthcare in Cooperstown, N.Y.

Just a few years ago, physicians focused on three components of cholesterol: total, HDL (good), and LDL (bad). But now the emphasis is primarily on LDL, Nissen says, because it seems to have the strongest link to heart disease. Ideally, adults should have an LDL level lower than 100, he says.

What to do: If you’re between ages 40 and 79, your doctor can use the ACC’s Heart Risk Calculator to estimate your 10-year cardiovascular disease risk based on such factors as age, diabetes status, and smoking history. To do it yourself, use the Heart Risk Calculator.

A 10-year risk below 7.5 percent is normal. For one between 7.5 percent and 10 percent, consider taking lifestyle measures, such as following a heart-healthy eating program, working out for at least 30 minutes most days, and staying at a healthy body weight—before you turn to medication, DeLong says.

For a 10-year risk over 10 percent, you may need to discuss taking a statin drug, such as atorvastatin (Lipitor and generic) or pravastatin (Pravachol), with your doctor. But these meds are usually not recommended for people 75 and older, Dale says, unless they’ve already had a heart attack or stroke, because risks may outweigh benefits.

For instance, older adults could have side effects such as muscle aches and pains, falls, and confusion. The drugs also may increase the likelihood of type 2 diabetes and cataracts. Discuss your cholesterol goals with your doctor. 

Blood Sugar

More than 25 percent of people older than 65 have diabetes, mostly type 2, says the American Diabetes Association. As a result, it recommends that beginning at age 45, everyone should be screened for diabetes every one to three years. For most adults, an HbA1c (a long-term measure of blood sugar) is considered normal when it’s less than 5.7.

What to do: If you’re told you have prediabetes (an HbA1c of 5.7 to 6.4), your first step should be a lifestyle change. “Most cases of type 2 diabetes stem from being overweight, so losing even 10 pounds can make a big difference,” says David Lam, M.D., medical director at the Mount Sinai Clinical Diabetes Institute in New York City.

The landmark National Diabetes Prevention Program found that people with prediabetes who dropped 7 percent of their body weight slashed their risk of full-blown diabetes by more than 50 percent.

Those who already have a diagnosis of type 2 diabetes should aim for an HbA1c between 7 percent and 8 percent, according to a 2018 ACP statement. “This seems to strike the best balance between benefits and risk,” DeLong says.

Two major trials—ACCORD and ADVANCE—found that going lower than this can raise the risk of death from heart disease in older adults. “They’re more susceptible to side effects from hypoglycemia (very low blood sugar), such as fainting or even coma,” Dale says.

If you’re 80 or older, or you have a chronic condition such as dementia, cancer, congestive heart failure, or end-stage kidney disease, the ACP recommends focusing on minimizing type 2 symptoms rather than a specific HbA1c target. 

Body Mass Index

Your doctor may determine whether you’re overweight by calculating your body mass index (BMI), which estimates your body fat using a ratio of your weight and height. (A healthy BMI is between 18.5 and 24.9.) But BMI may be unreliable in people older than 65. “It may underestimate body fat in older adults, who tend to lose muscle mass as they age,” Dale says.

Waist size may offer a more accurate assessment of body fat, he notes. An example: A 2019 study in JAMA Network Open of more than 155,000 postmenopausal women found that those with a normal BMI whose waist circumference was more than 35 inches were at a risk of dying from cancer or heart disease that was almost one-third higher than women with a normal BMI who had smaller waists.

What to do: Have your doctor check your waist circumference every year. For women, it should be under 35 inches; for men, under 40. If it’s wider, talk to him or her about weight loss and exercise.

Any physical activity can help reduce belly fat, but interval training—alternating bursts of intense activity and moderate activity or rest—may be particularly effective, at least for men.

When 70-year-olds with excess abdominal fat exercised three times a week for 18 to 36 minutes (they did 40 seconds of “work” followed by 20 seconds of rest) for 10 weeks, they lost almost three times as much fat as a control group, according to a 2019 study in the Journal of the American Geriatrics Society. And the male subjects shed a significant amount of abdominal fat. 

Bone Density

Women 65 and older should have a baseline bone mineral density test, according to the U.S. Preventive Services Task Force. The Endocrine Society advises that men 70 and older have these painless X-rays as well.

A T-score (the measure of bone density) of –1 and above is normal, says Robert Adler, M.D., chief of endocrinology and metabolism at Hunter Holmes McGuire Veterans ­Affairs Medical Center in Richmond, Va. A T-score between –1 and –2.5 indicates low bone mass (osteopenia), and anything lower signifies the brittle-bone disease osteoporosis.

What to do: If your results are normal, you won’t need another bone scan for at least 10 years unless you develop an important new risk factor, Adler says. For osteopenia, you should usually have a follow-up within three to five years.

Take lifestyle steps that support your bones. Older adults with osteoporosis who ate a Mediterranean-style diet rich in fruit, vegetables, nuts, unrefined cereals, olive oil, and fish were able to slow hip-bone loss within a year, according to a 2018 study in The American Journal of Clinical Nutrition.

Women older than 50 and men older than 70 also need at least 1,200 mg of calcium per day (8 ounces of skim milk have 300 mg), as well as 600 IU of vitamin D if they’re younger than 70 and 800 if they’re older. In addition, do at least 30 minutes of weight-bearing exercise, such as lifting light weights or walking, most days.

For full-blown osteoporosis, medications called bisphosphonates, such as alendronate (Fosamax and generic), are usually the first-line treatment, Adler says. 

Hearing

About one-quarter of people 65 to 74 and half of those 75 and older have disabling hearing loss, according to the National Institute on Deafness and Other Communication Disorders.

There are no professional guidelines on hearing exams for adults. But it’s reasonable to have a baseline check between ages 60 and 65, says Catherine Palmer, Ph.D., president-elect of the American Academy of Audiology. Normal for adults means you can easily hear anything at 25 decibels, or dB (a whisper).

What to do: If results are normal and you have no noticeable problems, get rechecked every two years, Palmer says. And guard what you have by wearing hearing protection, such as earplugs, when you’re around sounds louder than 85 dB (a lawn mower, leaf blower, or power tools) for a prolonged period.

If you have mild (26 to 40 dB) hearing loss, talk to an audiologist. Simple adjustments, such as looking at the person you’re talking with or reducing background noise (running water, for example) during conversations, may be enough.

But if you’re struggling despite these steps or your tests show significant hearing loss (about 40 dB or more), you may need an assistive device, such as a hearing aid. 

Vision

If your vision has worsened with age, you should still expect to see close to 20/20 with contact lenses or glasses. Another key vision number: eye pressure, which can indicate glaucoma if it’s high.

Normal pressure is less than 21 mmHg. But being in that range doesn’t guarantee that you’re in the clear, says Andrew Iwach, M.D., executive director of the Glaucoma Center of San Francisco and a spokesman for the American Academy of Ophthalmology. To rule out glaucoma, your doctor will also need to measure your cornea’s thickness and examine your optic nerve.

What to do: The AAO recommends that healthy adults have a comprehensive eye exam with an ophthalmologist by age 40. If you’re experiencing vision changes or problems, make an appointment with one immediately. If you’re 65 or older, see an ophthalmologist every year or two to be evaluated for eye diseases such as age-related macular degeneration, cataracts, and glaucoma. 

How Much Do Diet and Sleep Matter?

Here’s what research suggests you strive for when it comes to five key lifestyle steps.

Sleep
7 to 9 hours

You probably need just as much sleep now as you did in your younger-adult years, but your sleep-wake patterns may shift. The result: Many older adults may find themselves naturally waking up earlier than they once did.

Alcohol
Less than 1 or 2 drinks a day

Dietary Guidelines for Americans recommends that women have no more than one daily drink and men two. A 2018 analysis in The Lancet found that just one drink per day might raise the risk of diseases such as cancer.

Exercise
150 minutes a week

Adults should aim for this amount, according to the Department of Health and Human Services. This includes aerobic activity, such as brisk walking, plus muscle strengthening at least twice a week. Adults 65 and older should aim to include balance training as well.

Calories
Women: 1,800 a day; men: 2,200 to 2,400 a day

Dietary guidelines suggest these numbers if you’re older than 50 and moderately active—say, you walk anywhere from 1.5 miles to 3 miles daily. If you’re inactive, it’s 1,600 for women and 2,000 to 2,200 for men.

Fruits and Veggies
5 to 10 servings a day

Five daily servings of produce may reduce the risk of heart attack, stroke, and cancer. But the greatest benefits come from eating about 10 portions a day, according to a 2017 study in the International Journal of Epidemiology.

Editor’s Note: This article also appeared in the December 2019 issue of Consumer Reports On Health. 

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