Do you recommend increased screening for hypercortisolism in older patients given recent evidence that older patients do not commonly display hallmark symptoms of Cushing's Disease?

Well, the study you are referring reports that "younger patients were more likely to present with abdominal striae, acne, facial rounding, hirsutism, menstrual irregularities, and weight gain".

Obviously, menstrual irregularities cannot be seen in postmenopausal women. As for the rest, I am not sure...

In the CATALYST study, patients with difficult-to-control type 2 diabetes defined by a hemoglobin A1c (HbA1c) 7.5%–11.5% despite multiple therapies, were screened for hypercortisolism with an overnight 1-mg dexamethasone suppression test (DST). As reported at the ADA meeting in June 2024, ~24% excee...

Defining cushings with just a single overnight DST with cortisol cutoff of 1.8 ug/dl seems extreme to me. I will reserve judgement based on treatment outcomes.

I really do not see the need unless clinically indicated.