Chest
ReviewsGeriatric Respiratory Medicine
Section snippets
Pulmonary Function in the Elderly
Assessment of pulmonary function in the elderly is complicated by a number of issues. First, it is often difficult to ascertain whether the loss of respiratory function is due to aging itself or is due to respiratory illness, smoking, or protracted industrial or environmental exposure. Second, elderly patients are more likely to have concurrent illnesses or deconditioning that may directly or indirectly influence pulmonary function. Nevertheless, it has been established that even in the healthy
Exercise and Ventilatory Response in the Elderly
The ability to perform physical tasks declines with advancing age. Normal young adults are limited in exercise by cardiovascular adaptability (conditioning) and not by ventilation. Although the decrease in lung function with age outlined above may not be associated with ventilatory limitation under a normal eupneic state, there is loss of respiratory reserve, which may be unmasked by acute illness, surgery, or exercise.23,39 Factors responsible for this limitation include the small airway
Recognition of Asthma in the Elderly
Asthma in the elderly patient encompasses a number of important issues, the foremost being the need to maintain a high index of suspicion for this diagnosis, as it is often overlooked in older patients. The relatively recent rise in asthma death rates, greatest in those older than 65 years of age, is likely to be due, in part, to under-recognition and undertreatment of asthma in the elderly, and the existence of comorbid diseases in the aged.52, 53, 54 Yet, asthma hospitalization rates are
COPD IN THE ELDERLY
COPD, defined as chronic bronchitis or emphysema, is a disease the prevalence of which increases in the sixth decade, thus making it a disease of the elderly. Because COPD is principally a geriatric disorder, we have not written a comprehensive review but have focused our discussion on the salient features of the therapeutic armamentarium. By a 1989 estimate, there are about 12 million Americans who have chronic bronchitis and 2 million who have emphysema.117 Predictors of poor survival in COPD
Epidemiology of Pulmonary Embolism in the Elderly
A recent assessment suggests that there are 300,000 to 600,000 cases of pulmonary embolism (PE) or deep vein thrombosis (DVT) each year in the United States.148 The risk for venous thromboembolism rises with age.149,150 In Italy, the incidence of venous thromboembolism peaks in the seventh to eight decade of life.151 In the United States, the annual incidence at ages 65 to 69 is estimated to be 1.3 and 1.8/1,000 population, respectively, for DVT and PE, which by ages 85 to 89 increases two-fold
Waning of the Immune System in the Elderly
Although a decline in the innate (neutrophil) and specific immunity (lymphocytes) has been observed in the elderly, in many cases it is not clear whether the defect is primary or secondary to an underlying systemic disorder such as cancer. Furthermore, investigators have been unable to substantiate a relationship between the level of cell-mediated or humoral immunity and the risk of nosocomial pneumonia in the elderly.169 Diet and exercise may also influence age-related changes in the immune
Epidemiology of Tuberculosis in the Elderly
Several important epidemiologic points characterize tuberculosis (TB) infection in the elderly. First, the rates for active TB cases are higher in the elderly than in young adults,260 despite the fact that skin test reactivity against purified protein derivative (PPD) decreases with increasing age.261 For example, 53% of all TB cases are in the 14% of people older than 65 years of age.262 Second, TB case rates are four-fold higher (234 cases per 100,000 cases in 1985) for residents of nursing
Sleep Changes with Aging
Sleep patterns change with normal aging compared to the patterns in young adults, and sleep disturbances are more common for the elderly. According to Dement et al,286 “the strongest and most consistent factor affecting the pattern of sleep across the night is age,” although data to support this for the oldest elderly, those above age 80, are scant. At least 20 to 40% of all adults have sleep-related symptoms, the majority of which are insomnias.286 Nearly 2 decades ago, Block et al287 noted
Lung Cancer in the Elderly
Lung cancer is the leading cause of cancer-related deaths in the United States, the United Kingdom, and a number of other countries for both men and women.332 The overall prognosis for patients with lung cancer remains grim, with a 5-year survival rate of 14%. The incidence of lung cancer is increasing because of the rise in the aging population coupled with the fact that lung cancer is primarily a disease of the elderly, peaking in the eighth decade and due likely to longer exposure time to
Acknowledgment
We thank Drs. Charles Irvin, Michael Iseman, Barry Make, and York Miller for critical reviews of the manuscript. We are also grateful for the expert illustrative assistance of Leigh Landskroner, Barry Silverstein, Nadia DeSteckelberg, and Martin Kondreck.
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