Thursday, November 21, 2024
Subscribe American Journal of Medicine Free Newsletter
CardiologyTop 10 List for the Cardiovascular Care of Older Adults

Top 10 List for the Cardiovascular Care of Older Adults

doctor holds tablet and talks to patient

Cardiovascular medicine is disease oriented, technology driven, evidence rich, and focused on saving lives. Geriatric medicine is syndrome oriented, technology-avoiding, multidisciplinary, and focused on preserving quality of life. The tenets of these disciplines are divergent, yet their integration affords a richer platform for the cardiovascular care of older adults.1 Cardiovascular guidelines recommend treatment based upon evidence gathered predominantly in 50–60-year-olds. While a cardiac condition may exist in isolation in younger patients, at age 80 years this is often not the case. In older adults, treatments may result in larger benefits given higher absolute risk, but can be offset by adverse effects attributable to age-related changes in the cardiovascular and other organ systems. Additionally, outcomes of interest to older adults differ from those in younger individuals. The heterogeneity of aging further adds to the inherent complexity of care.2 Examples of healthy aging at the extremes of age remind us that functional status and frailty are as relevant as age itself in predicting the resiliency of an older patient.3 Diagnosis and treatment plans must consider multiple interacting systems, where a sudden change in function may be the only sign of a problem. Shortness of breath may result from chronic obstructive pulmonary disease with just a mild degree of heart failure; worsening angina may result from anemia in the context of an occult gastrointestinal bleed rather than progressive coronary disease; and an elevated troponin value may reflect myocardial injury from hypoxemia in a patient with community-acquired pneumonia, rather than an unstable coronary plaque.4 Finally, while we advocate for the promise of modern medicine and pursue aggressive care in many, when we cannot cure, we must still care for our older patients. All practitioners should have a working knowledge of palliative care to enhance choices.5 The list below highlights the top 10 ways to integrate these concepts for the cardiovascular care of older adults.

1.Older Adults Are Not Just Adults with Gray Hair

This headline is the geriatric equivalent of the pediatric maxim, “Children are not just small adults.” Aging is associated with substantial alterations in cardiovascular structure and function that influence pathophysiologic mechanisms, predispose to the development of cardiovascular disease, reduce cardiovascular reserves, and increase risk for adverse outcomes. Normal physiologic changes with aging alter safe and effective care.

2.Frailty Is the Vital Sign of Old Age

Frailty is a biological syndrome that reflects a state of decreased physiologic reserves and vulnerability to stressors. The majority of older adults are not frail, so identifying those who are is as important as detecting those who are not. Incorporate geriatric assessments as part of vital screening, as frailty, geriatric syndromes, and cognitive impairment are critical factors in older adults.

3.Embrace Complexity

The passage of time is associated with increasing heterogeneity across individuals of the same chronologic age. Also, symptoms pose a great masquerade in older patients—worsening hypertension, fatigue, or dizziness may be atypical presentations of typical conditions. To prepare, think broadly and critically.

4.Treat the Cardiac Condition in Context

Cardiovascular disease in older adults almost never occurs in isolation, so optimal management requires consideration of comorbidities.

5.When in Doubt, Ask the Patient (or Family, or Caregiver)

Shared decision-making is prefaced on adequate communication and understanding. Assessing knowledge, preferences, and goals of care often requires inclusion of caregivers and family as well as generational and cultural sensitivity.

 

To read this article in its entirety please visit our website.

-Karen P. Alexander, MD, Michael W. Rich, MD, Daniel E. Forman, MD, Nanette K. Wenger, MD, John A. Dodson, MD, Joseph S. Alpert, MD, James N. Kirkpatrick, MD, Mathew S. Maurer, MD

This article originally appeared in the September 2016 issue of The American Journal of Medicine.

Latest Posts

lupus

Sarcoidosis with Lupus Pernio in an Afro-Caribbean Man

A 54-year-old man of Afro-Caribbean ancestry presented with a 2-month history of nonproductive cough, 10-day history of constant subjective fevers, and a 1-day history...
Flue Vaccine

Flu Vaccination to Prevent Cardiovascular Mortality (video)

0
"Influenza can cause a significant burden on patients with coronary artery disease," write Barbetta et al in The American Journal of Medicine. For this...
varicella zoster

Varicella Zoster Virus-Induced Complete Heart Block

0
Complete heart block is usually caused by chronic myocardial ischemia and fibrosis but can also be induced by bacterial and viral infections. The varicella...
Racial justice in healthcare

Teaching Anti-Racism in the Clinical Environment

0
"Teaching Anti-Racism in the Clinical Environment: The Five-Minute Moment for Racial Justice in Healthcare" was originally published in the April 2023 issue of The...
Invisible hand of the market

The ‘Invisible Hand’ Doesn’t Work for Prescription Drugs

0
Pharmaceutical innovation has been responsible for many “miracles of modern medicine.” Reliance on the “invisible hand” of Adam Smith to allocate resources in the...
Joseph S. Alpert, MD

New Coronary Heart Disease Risk Factors

0
"New Coronary Heart Disease Risk Factors" by AJM Editor-in Chief Joseph S. Alpert, MD was originally published in the April 2023 issue of The...
Cardiovascular risk from noncardiac activities

Cardiac Risk Related to Noncardiac & Nonsurgical Activities

0
"Assessment of Cardiovascular Risk for Noncardiac and Nonsurgical Activities" was originally published in the April 2023 issue of The American Journal of Medicine. Cardiovascular risk...