In a study of 4,020 trauma patients, Johnston et al, in this issue of CHEST (see page 653), have shown that the relationship of age to the risk of developing ARDS is much more complicated than might be expected. There was a progressive increase in risk with age, reaching maximum values in patients who were 60 to 69 years old. However, the risk appeared to decline thereafter, and there was no greater risk in the group of patients who were > 80 years old than in patients who were 13 to 19 years old. The interpretation of this trend may be related in part to differences in the treatment of the very elderly, in whom a less aggressive approach is likely. However, alternative explanations are possible.