Worth separating two things that post #59 runs together.
I would rather this thread reach "we do not know" about older adults than reach a confident answer that nobody can support when asked.
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Clinical · Special populations · continued
Older adults, sarcopenia risk, and the trade-off nobody quantifies posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
c.silva, post #38: Counterpoint on older adults, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out. Go to post
Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.
Worth saying I have only my own numbers here, and n is small.
n.villalobos, post #25: For anyone finding this later: the short answer on older adults is that it depends on one thing, and the rest of the thread is people identifying which thing. Go to post
Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.
I would want the raw data before agreeing with my own summary of it.
b.fonseca, post #33: Checked the older adults claim against the primary source this morning. It survives, with a narrower scope than the version quoted here. Posting the narrower scope. Go to post
Narrowing post #67, because the general version has more than one answer.
The useful distinction on older adults is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.
a.thorne, post #3: Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done. This is the version I would want a new member to read first. Go to post
Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.
A weak preference rather than a position.
Hypoglycemia risk: in people already on insulin or sulfonylureas, adding a GLP-1 agonist requires insulin dose reduction and close monitoring for hypoglycemia. This is manageable with attention.
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g.radich, post #6: Fair, and the limits you put on it are the part I will remember. Go to post
I read post #68 twice before replying, because I had assumed the opposite.
The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.
e.steiner, post #23: Two things can be true about older adults at once: the mechanism is plausible and the evidence for the size of the effect is thin. Most of the argument here is people defending the first against attacks on the second. Go to post
Sensible. I would want the same detail before I acted on it either.
Two people in this thread mean different things by older adults and are disagreeing about the definition while believing they are disagreeing about the facts. Worth pausing to define it.
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Collapsed as off-topic by two members at trust level 3 or above
Coming back to post #72, because the follow-up matters more than the original answer.
I have no financial interest in anything named in this thread and I want to say so before I comment on older adults, because it is the sort of subject where it matters.
Confirming post #77 from a second method, which matters more than confirming it from a second person.
Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.
The strength of my opinion here exceeds the strength of my evidence.
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v.rautio, post #19: I would keep older adults and the decision it usually gets used for separate in this thread. They are related and they are not the same question, and merging them is why the last one went badly. Go to post
Dedicated trials in under-studied populations are the only real remedy and several are ongoing, which is worth saying rather than speculating.
A partial answer, offered because a partial answer beats none.
z.okonkwo, post #56: Older adults: sarcopenia risk is higher, polypharmacy is common, and the clinical trials did not enroll many people over 75. Extrapolating to very old people is extrapolating beyond the data. Go to post
Older adults were included in the trials in smaller numbers than their share of the eventual population, so precision in that subgroup is poor.
c.silva, post #38: Counterpoint on older adults, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out. Go to post
Post #81 is right about the mechanism and I think understates the practical bit.
The documentation on older adults is better than this thread and I say that as someone who has posted in the thread.
Offering a way to settle older adults rather than another opinion about it. Two measurements, taken the same way, a fortnight apart. If the difference is within the noise, the question was not answerable at this precision.
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l.osei, post #68: Narrowing post #67, because the general version has more than one answer. The useful distinction on older adults is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars. Go to post
I had written a reply contradicting post #86 and deleted it. Here is what survived.
Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.
It reads as pedantry until the day it does not.
Confirming post #86 from a second method, which matters more than confirming it from a second person.
The bit of older adults that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge.
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a.thorne, post #3: Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done. This is the version I would want a new member to read first. Go to post
Two sentences on older adults and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
s.roos, post #72: I read post #68 twice before replying, because I had assumed the opposite. The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question. Go to post
Adding the measurement that post #89 says would settle it.
Older adults: sarcopenia risk is higher, polypharmacy is common, and the clinical trials did not enroll many people over 75. Extrapolating to very old people is extrapolating beyond the data.
It is one reading of the data and not the only reasonable one.