An article by Dr. Olha Krysiuk, Physician of
Aging is a natural process. According to the analysis, the percentage of the population over 65 years of age in developed countries has increased in the last 10 years and will continue to grow for another 20 years. It is estimated that by 2050, the Number of people aged 80 and over worldwide could triple compared to 2015. Aging is known to be the predominant risk factor for most diseases and conditions that limit life expectancy.
The chronic diseases cause multiple health problems and, therefore, are an important determinant of quality of life. Conditions so common in old age such as hypertension, respiratory and cardiovascular diseases, in patients with Covid-19 are associated with a high risk of a more serious condition, which has become a serious problem. This article reviews current information on chronic ailments in seniors and the elderly .
In Spain, death and disability, following global trends, have been more associated in recent years with non-infectious diseases. Cardiovascular diseases, neoplasias, mental disorders and neurological disorders are the main causes. Specifically, in 2016 in Spain, 80.5% of all deaths occurred in the group of people over 70 years of age. The top five specific causes of death were:
- coronary disease (coronary heart disease, 14.6% of all deaths)
- Alzheimer’s disease and other types of dementia (13.6%)
- stroke (7.1%)
- chronic obstructive pulmonary disease (6.9%)
- lung cancer (5.0%)
With age, the probability of development and decompensation of most chronic diseases increases
This review will identify the most common comorbidities in older patients age 65, relevant statistics, and will briefly describe the main problems associated with chronic diseases in the elderly population.
With age, the probability of development and decompensation of most chronic diseases. However, a series of relatively pathological conditions characteristic of a general weakening of health, often accompany the population of 65 years or older.
Among them is, for example, hearing loss (presbycusis). The prevalence of hearing loss increases with age and accumulation of risk factors, and is largely associated with decreased quality of life. It is estimated that almost 50% of adults over the age of 85 have hearing impairment. Furthermore, there is evidence that a increased social isolation it indirectly leads to the development of depression and may contribute to a decline in cognitive functions. Despite the fact that the use of hearing aids can reduce the impact on quality of life and cognitive function in the elderly, according to statistics only 14.6% report the use of hearing aids at the present time. .
Likewise, the visual acuity usually decreases with agepresbyopia). A longitudinal study in the UK of a population aged 75 and over found that the prevalence of severe visual impairment was 23% in the 85-89 age group and reached 37% by age 90. It is known that the Vertigo is a multifactorial geriatric syndrome common that often leads to falls. Vestibular function can decline with age, so vestibular rehabilitation is recommended.
Furthermore, in older patients the muscle mass and muscle strength decrease. By age 85, about 20% of people meet the criteria for significant loss of muscle mass and strength. What chronic inflammation, decreased hormone levels, muscle cell mitochondria dysfunction, and stem cell dysfunction are all contributing to.
The immune system changes they are conditioned by chronic inflammation and chronic proinflammatory conditions. Decreased B-cell function, decreased T-cell production, altered T-cell activation, and innate immune dysfunction are observed. Such changes weaken the body’s ability to fight infections such as the flu and shingles in the elderly. Vaccines are generally not as effective for older people. Special mention should be made of the relationship between age-related changes in immunity and the high severity of manifestations of Covid-19 infection in the elderly (details later).
It is believed that in older people the bladder often “it’s not sterile” but it is “populated” of bacteria that do not cause infections. The Asymptomatic bacteriuria it is more common in women than in men, and is more common in hospitalized patients and residents of long-term care facilities (with up to 50% of these high-risk groups being women). The use of antibiotics in this situation is not justified and may contribute to antimicrobial resistance.
Cardiovascular diseases
The cardiovascular diseases they remain the most common cause of death for older people, although death rates have declined over the past 20 years. This category includes chronic ischemic heart disease, congestive heart failure, and arrhythmias.
In older people the coronary artery disease can be underestimated. Normal aging includes vascular remodeling and vascular stiffness. The atherosclerosis it causes inflammation and consequent vascular changes, increasing the risk of cardiac events, cerebrovascular events, peripheral vascular disease, cognitive impairment, and other organ damage. According to the statistics of previous years, in Europe about 56% of patients older than 70 years have mitral or aortic valve stenosis. Unfortunately, many elderly patients have serious comorbidities that expose them to excessive surgical risk.
In older people, the symptoms of coronary artery disease are more difficult to detect than in younger patients, for several reasons. Elderly patients are often sedentary and may not have exercise-induced symptoms. Although the chest discomfort remains the most common complaint of patients with coronary artery disease, the elderly have a higher percentage of complaints of atypical chest pain, as well as pain outside the chest. As well as general weakness / malaise, shortness of breath, abdominal pain, nausea and vomiting or fainting.
Although patients 75 years of age or older account for 32% to 38% of patients with non-ST-segment elevation acute coronary syndromes in registries, this group represents only 18% of the study population in clinical trials.
Hypertension
Hypertension, the main cause of atherosclerosis, is the most common chronic disease in the elderly. Isolated systolic hypertension is especially common among the elderly and is associated with mortality. Hypertension is one of the main modifiable risk factors for cardiovascular disease (CVD) and its prevalence and severity increase with age.
Research has shown that 70% of adults ≥65 years have hypertension. This number is likely to continue to increase as our population ages and is expected to increase as much as 20% by 2050. Despite being more susceptible to hypertension and the increased risk of cardiovascular disease and mortality in their age group, the elderly may not be receiving the appropriate treatment. .
Hypertension is known to be the “companion” most frequent of other cardiovascular diseases and is an unalterable risk factor for conditions as serious as heart attack and stroke. In this sense, the reduction of the risks associated with hypertension lies in the area of adequate therapy and control of blood pressure.
The use of intensive pharmacotherapy for hypertension in people older than 75 years remains controversial. The available evidence suggests that aggressive treatment may need to be offered and continued as long as it is well tolerated and compatible with the patient’s goals.
Cancer
He Cancer is the second leading cause of death in older people. Interestingly though, at the age of 85, cancer deaths begin to decline. Slow-growing tumors are more common among patients in this age group. This is because the response to cancer treatment depends on performance status, not age. Regardless, people in their ninth or tenth decade of life should not be denied aggressive cancer treatment because of their age.
With respect to diagnosis and detection of neoplasmsscreening for breast cancer after the age of 75 due to insufficient evidence of its benefits. Similarly, for people age 75 and older in the United States, screening for colon cancer it is recommended only in cases when a long life expectancy is predicted and a high ability to tolerate cancer treatment is expected, if necessary. On the other hand, screening for prostate cancer due to frequent false positive results.
Osteoarthritis and osteoporosis
The Osteoarthritis is the second most common chronic ailment among the elderly in the United States and a common cause of chronic pain and disability. According to data from one study, 52% of 85-year-olds are diagnosed with osteoarthritis.
The obesity, which is often seen in the elderly, is a risk factor for osteoarthritis, and as the population ages (and especially as the overweight population ages), the incidence of severe hip and knee arthritis increases. As such, since virtually all pain relievers pose a significant risk to the elderly, pain relief will continue to be a major clinical and public health issue.
Many people over the age of 85 suffer from osteoporosis, as well as a more severe decrease in bone density. Osteoporosis is associated with a higher incidence of bone fractures. Bone density screening is recommended for women over the age of 65. Although the prevalence of fractures in men increases at age 85, the value of screening for osteoporosis in men has not been clearly demonstrated.
Diabetes
The number of patients with diabetes increases as the population ages and becomes overweight. One study cites the alarming prediction that the prevalence of diabetes among older adults in the United States could increase by more than 400% by 2050. Diabetes remains a major risk factor for cardiovascular diseases at 85 years old.
Diabetes is also associated with peripheral arterial disease and peripheral neuropathy, contributing to serious and significant complications. The…