There's one worry older patients bring up constantly with Peter Attia, a US physician who specialises in longevity.
It's not about how to live an extra few years, or whether they're likely to die at 85 or 90.
"They're most afraid of the deterioration in their quality of life in the last decade," Dr Attia tells ABC RN's Life Matters.
"They want to know that they can pick up their grandkids from the crib. They want to know that they can still go for a walk and if the terrain is a little bit rugged, they're not automatically going to fall down.
"These are the things that matter to people, and these things they have to be trained for — they have to be prepared for."
And yet, Dr Attia argues people in many western countries don't have access to the information they need to be prepared.
"We don't really put [prevention] into practice," he says.
Dr Attia argues there's a "default" position that assumes the last decade of life is one in which "your cognitive and physical capacity are less than half what they were in midlife".
But he says it doesn't need to be that way. There are actions people can take immediately to improve the length, and importantly the quality, of their life.
"What we're really talking about here is making sure that the last decade of your life is exceptional," Dr Attia says.
And he says the information we need to do that is already on-hand.
"We know much more than we're taking advantage of today."
Cardio, muscle mass and strength
There are three factors important to quality of life in ageing, says Dr Attia, author of Outlive: The Science and Art of Longevity.
Together, they offer a benefit that is "more than twice the magnitude of the harm brought on by smoking, diabetes, high blood pressure" and other things that reduce life span and quality of life, he says.
"There's simply nothing that compares to having a high degree of cardio-respiratory fitness as measured by VO2 max [the maximum oxygen uptake during intense exercise], having a high degree of muscle mass ... and having high strength."
Let's break that down.
Dr Attia's starting point with patients looking to improve their fitness is: "Tell me what you're doing now, and I'll tell you what might be the next best step".
"If you take an individual who is doing nothing, we know pretty clearly that getting them up to three hours a week, say six 30-minute bouts of exercise a week, will [significantly] reduce their all-cause mortality — meaning their death from any cause," he says.
"We simply don't have other interventions that come close to that," he argues.
Someone already exercising three hours a week who moves up to six hours "won't get quite the same bang for [their] buck" but will see a "continued increase and improvement in outcomes", he says.
When it comes to strength and muscle mass, his most important nutritional tip is to ensure you're consuming enough protein.
As we age, it becomes harder for muscles to repair and to preserve muscle mass — and protein helps that.
"One of the biggest things we certainly see here in the US, but I suspect that this is true across the world, is that people are not getting sufficient amounts of protein to preserve lean mass. And the consequences of this are actually devastating," Dr Attia says.
Lack of balance, lack of muscle mass and frailty are all big risk factors in someone over the age of 65 falling, he says.
And in this population, a fall that leads to a broken hip, for example, is associated with increased mortality rates.
Poor die younger than rich
With economic growth and medical advances, overall life expectancy in many developed countries has continued to improve, says Han Li, an associate professor in economics at the University of Melbourne who specialises in mortality and longevity.
However, she says things don't look as promising up close.
In certain geographical areas, such as those poorly serviced by hospitals or with lower socio-economic status, "we usually find large, long-lasting and increasing … inequalities in mortality experience", Dr Li says.
She points to 2014 data that showed life expectancy varied by more than 20 years across US counties.
Australia's smaller population size makes similar data difficult to obtain, but she says "such an issue may also exist".
"In the last decade, I think this is probably true for both US and Australia, because they're both developed countries, certain segments of the population may have experienced a stagnation or even an increase in mortality rate, especially for the lower socio-economic group."
Generally, the poorer you are, the shorter your life span is likely to be, Dr Li says.
A 2020 study in the Australian Population Studies journal showed the poorest Australians are twice as likely to die before the age of 75 than the richest.
Therefore, when we speak about improving quality of health in ageing, we have to acknowledge that not everyone starts at the same point.
"You don't want to only improve the overall [health outcomes]; you also want to look at the more granular level, like whether everyone — or most of the groups — are getting the benefit," Dr Li says.
The more we look into the different factors impacting different population groups, the more we move towards more equitable health and longevity outcomes, she says.
Don't forget emotional health
Emotional health or emotional capacity is often missing from traditional medicine, Dr Attia says.
"Everybody kind of understands that as you get older your cognition declines, your strength declines, your stamina declines, your pain increases.
"But emotional health is something where you can be suffering at any age. And … from a positive standpoint, at any age you can improve it. My emotional health today at 50 is much better than it was at 40."
When emotional health is "out of whack", Dr Attia argues that pursuing other forms of health is almost redundant.
"There is no reason that I can understand why you would want to live longer in any state of health, good or otherwise, if you're unhappy, and if your relationships with other people are compromised, if your relationship with yourself is compromised. It just doesn't seem like it's a life worth living," he says.
Please note: the information in this article is general. Before making health, fitness or nutrition decisions, consult a medical practitioner for individualised advice.
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