In this new series for the Herald, I’m not going to be the expert – I’m not medically qualified – so on clinical matters I will revert to the experts. Instead, l will take the position I am well qualified to take – that of an adult child, watching her parents get older and wanting to help them navigate this next phase with confidence and peace of mind. I also don’t mind ruffling feathers – in fact I think it’s high time for some ruffling – because the way we support older New Zealanders is simply not acceptable.

My mum is in her late 60s and has started waking at 4am. Discussions with her friend revealed she, too, was waking early – so between them they decided “we’re just getting old, it’s normal”.

But is it? Do we too easily assume that inexorable decline is simply inevitable as we age?

“All. The. Time,” says Geriatrician Dr Cheryl Johnson, who wants to challenge that nihilistic pattern of thinking. She often sees patients who “plonk themselves down in my clinic room and say, ‘I’m just getting old’”.

Of course, things will change as we get older. “Every organ system gets affected by ageing,” she says, “but that doesn’t necessarily lead to disease or to specific changes.”

The healthcare system is typically reactive, and – as we all know – stretched very thin. But there is much we can do that’s preventative and proactive (and much less dramatic than getting an infusion of your child’s plasma a la billionaire Bryan Johnson!).

Some tests that can diagnose disease are publicly funded, for example national screening programmes for breast, bowel, prostate and cervical cancer, each of which is funded from a different age.

But what else is available, and what is worth paying for yourself?

I spoke to Johnson at length in my podcast The Next Bit, which focuses on all the ways we can make the next stage of life worth living, rather than an unsteady shuffle to the grave.

The first self-funded test that came to my mind, I hate to admit, was inspired by The Kardashians – the $499 “TruAge” test that shows your biological age versus your chronological age, and the pace at which your body is ageing. I mean, who wouldn’t want to be Khloe Kardashian at 40 with a biological age of 28?

But Johnson offers a note of caution.

“It’s a little bit reductionist, I think. Maybe I’m 75, but my biological age is 70 … I pat myself on the back and think that I’m doing okay. But in reality, I think it’s a lot more complicated than that.”

Genetics play a role in how you age, and specific gene mutations can dramatically increase the chances of developing disease – which has sparked an increase in people requesting genetic testing.

While gene testing in some circumstances is appropriate, Johnson says the most common one she’s asked about by patients is whether they may have the “gene” for dementia, because someone in their family may have developed it in the latter stages of their life.

“There are some genetic mutations that are associated with dementia, but they’re rarer and generally associated with younger onset disease. For the vast majority of patients seen for changes to their cognitive function, we don’t do genetic testing for dementia specifically. It has a lot of implications and even if you have the gene, you may not get the disease.”

While not an advocate for gene testing for dementia, she says getting a holistic assessment as soon as you have concerns is key. With early assessment and intervention, decline can be reversed.

“Even when people are diagnosed with dementia, there are things that we can do to help stabilise and improve their memory. And this can be true for almost all domains of health, not just dementia. In fact, some diseases like frailty and osteoporosis can be reversed.”

She stresses that looking at individual organs or aspects of health in isolation often isn’t helpful, because ageing cuts across all domains of health, and this complexity intensifies as we age.

For example, Johnson says: “We know that cardiovascular disease underpins most of the different types of dementia” – meaning that blood pressure and cholesterol checks, which are available through your GP – are not only important for maintaining your heart health, but also your brain health.

You also need to know whether you have any vitamin deficiencies.

“Vitamin B12 deficiency increases as we get older … too much alcohol might mean you’re thiamine deficient. Addressing those factors early is really important for your bodily and particularly neurological functions.”

There are a number of baseline blood tests that your GP can order for older adults, and would therefore be free – like B12, Cholesterol, HbA1c (used to detect diabetes) – but they’ll only do so if there are clear “clinical indications”. So, simply being worried or curious may not be sufficient. Vitamin D deficiency can increase the risk of muscle weakness and risk of fractures – but you may have to pay for it privately. BodyIQ offers the test for $75.99, for example.

Getting an osteoporosis test, or even simple tests like grip strength and a “timed up and go” from a geriatrician can help identify risks before there are clinical signs that might justify a funded blood test.

All of which made me think – should we simply be downing supplements by the handful, to cover our bases?

“The trouble with supplements is they haven’t really been extensively studied the way that more traditional medicines have been studied. Most of them don’t have a great deal of evidence for their use or effectiveness,” Johnson says.

While I feel a bit disheartened that my supplements might not cut the mustard as hoped, Johnson’s overriding message is actually very heartening for anyone ageing or watching someone they love age.

“The adage of you can’t teach an old dog new tricks actually doesn’t really apply. There are things that you can do no matter how old you are. There are still things that are going to make life better for you. A lot of decline we put down to ageing is in fact preventable or treatable.”

Hannah McQueen is the founder and director of EnableMe, the founder of Age Brightly, and the host of The Next Bit podcast.

Health test costs in New Zealand, and their effectiveness

Breast, bowel, prostate and cervical cancer screening

Cost: Free – if within screening ages

Worth it? Yes – always. Proven, early detection saves lives.

Biological Age test

Cost: $499

Worth it? Generally no. Composite scores can be misleading for older adult health and mask individual risk markers.

Genetic Testing

Cost: Private, $300–$2000. Requires specialist referral and supervision of results

Worth it? Sometimes. Proceed with caution. Moderate value for clear hereditary risk; low value for broad curiosity testing.

Note: a positive genetic test does not necessarily mean the person will get the disease and requires an in-depth understanding of the genetic test and disease.

Self-funded blood tests (eg Vitamin D)

Cost: Approximately $75, multiple times per year.

Worth it? Sometimes. Useful to guide supplementation; risk of fluctuation of result depending on time of year, so likely need to self-fund more than once.

Geriatrician assessment

Cost: $500–$1000 per hour

Worth it: Often yes. Excellent for complexity; limited preventive scope and continuity. Usually working independently without a multi-disciplinary team of specialists supporting the patient. Long wait times as limited availability and not available in some regions.