For older adults, managing health problems like diabetes and high blood pressure can lead to a better life—fewer complications, more independence, and even a longer lifespan.
But sometimes, too much medical care can backfire. When treatments are too aggressive, they may cause serious harm.
Every day, many older people in the U.S. are hurt because their blood sugar or blood pressure drops too low from over-treatment.
This can lead to emergency room visits, hospital stays, disability, or even death. These problems are often caused by well-meaning doctors who are simply doing too much.
Although there are guidelines that tell doctors to be more careful—especially with frail seniors or those in nursing homes—over-treatment is still far too common.
Dr. Joseph Ouslander from Florida Atlantic University and Dr. Michael Wasserman from the California Association of Long-Term Care have raised the alarm in a new article.
They say doctors, nurse practitioners, and physician assistants need more support and better tools to avoid doing more harm than good. Instead of following strict numbers for blood sugar or pressure, they believe care should be based on what’s best for each patient.
Dr. Ouslander explains, “Sometimes, trying too hard to control a disease can actually hurt the patient. We need new systems that reward safe, personalized care, not just low numbers.”
For diabetes, major medical groups like the American Diabetes Association already suggest more relaxed targets for older adults in poor health. For example, allowing a slightly higher blood sugar level can lower the chance of dangerous drops (called hypoglycemia). But in real life, many older people are still given strong medications or tight diets that put them at risk.
Similarly, with high blood pressure, current advice suggests a moderate target—usually between 130 and 150 for systolic blood pressure—for people over 80. But many big studies exclude frail or sick older adults, so the results might not apply to the most vulnerable people.
One well-known study, the SPRINT trial, showed that strict blood pressure control could reduce health problems. However, it did not include people with serious illnesses, dementia, or those living in nursing homes.
In their paper, the doctors give a list of changes that could make care safer:
Test safer treatments: Try new medicines and tools made especially for older people.
Focus on quality: Help clinics and nursing homes do a better job managing diabetes and blood pressure.
Use smart data: Look at patient records to find people at risk of low blood sugar or pressure.
Personalize care plans: Work with patients to set goals that match their health and wishes.
Work as a team: Get researchers, doctors, and policymakers to build better safety strategies.
Track the right numbers: Create ways to measure when doctors are over-treating patients, not just under-treating them.
Do more research: Study older adults in the real world to find what really works for them.
Dr. Ouslander says the current approach needs a major shift. “We have to stop aiming for perfect numbers and start aiming for the best outcomes for the person. This is about safety, dignity, and doing what’s right for each individual.”
He believes it’s not just a medical issue—it’s an ethical one. The goal should be smarter, safer care that helps older people stay out of the hospital, live better lives, and make choices that suit their values.
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