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A study published just a few days ago put six questions about health care preferences to 6,098 English adults aged 50 and over, drawn from the English Longitudinal Study of Ageing. (read it here)

The questions covered how much risk someone would accept, present against future quality of life, quality against length of life, function against appearance, willingness to try an experimental treatment, and whether they would rather their doctor made the decision.

People aged 75 and over were more likely than the 50 to 64 group to want the doctor to decide. They were also more cautious about risk and less willing to try something experimental.

The same preference was more common among people with less education.

Women went the other way on that question. They were less likely than men to hand the decision over, and more likely to choose quality of life over length of it.

Which puts wanting to decide alongside the other five as a preference in its own right. It varies by age, by sex, and by education, the same way the others do.

Most of what the sector has built over the past decade runs on choice — the conversation, the plan, the options laid out, the signature at the end. That works well for the person who wants to weigh it up. But for the person who would rather someone with training made the call, a list of options is a different experience.

So there's a second question sitting next to "what do you want" — how much of this would you like to decide yourself. On this evidence the answer moves with age, and it's one we can only get by asking.

Wednesday 23 September | 10.30–11.30am ACST | Online | Free

Join us for the first Ageing Reframed panel.

Our sector has embraced dignity and person-centred care. It has paid far less attention to identity — the person's sense of who they are — and the part it plays in how people make decisions and adopt behaviours. Whether someone seeks help, stays on a medication, or accepts support at all often turns on whether the step sits with who they take themselves to be.

The panel works through that across three live problems: ageing in place and the family carers who sustain it; delayed help-seeking and medication; and culturally safe everyday care under the new Aged Care Act. With geriatrician Dr Sanka Amadoru, and Behaviour ID's Mat Crompton and Kris White.

This one sits outside the usual territory. My friend Ethan Tan launched his new venture this week: Cart 8, a marketplace for South Australian food. Dozens of local producers in one cart, delivered to your door. SA customers only (for now).

Good to see someone building a way for local producers to reach more homes. Have a look at cart8.com.au.

The New York Times reviewed hundreds of ads featuring AI-generated doctors, healers and wellness influencers promoting supplements, with claims like treating kidney disease better than medication, aimed especially at older American women. Claims which would be illegal on TV are freely shown online, as enforcement is thin. (watch it here)

An interactive story by the artist Gaia Alari for The New Yorker. Her father Gabriele was dying, so she started building a chatbot of him — feeding it his memories, photos and history — and he joined in enthusiastically, uploading his own material. She talked to it while he was still alive, and the version of him in the bot apologised for things he wouldn't have, which she found comforting and hard to sit with at the same time. (read it here, very well put together)

Forty years ago about three in ten Americans aged 85 to 89 had dementia; by 2024 it was around one in ten, and between 1988 and 2015 the share of older people diagnosed fell roughly 13% a decade across six countries in North America and Europe. (Total numbers keep climbing, because more people are reaching the ages where dementia is common.) (linkedIn post here, and the underlying research here)

Each week, I review developments in ageing and aged care and what they mean in practice. If this was useful, forward it to someone in the sector who'd appreciate it.

George Gouzounis