Diseases in the Elderly

Reference: Case Files in Geriatrics (2014). McGraw Hill Education.

Angina may present with atypical symptoms like dyspnea, sweating, nausea and vomiting, fatigue and weakness or light headedness. Silent myocardial ischemia is more common. 

Heart failure
Heart failure is more common in the elderly than in the general population. Coronary artery disease is often the cause in elderly men while hypertension is often the cause in elderly women. 

Aortic stenosis
Aortic stenosis is a common valve disorder in the elderly. This is because of degenerative changes and calcification of the valve. A murmur that arises at the aortic area in the elderly can also be due to aortic sclerosis which is non-obstructive. Aortic stenosis that is symptomatic must be evaluated for aortic valve replacement. 

Diagnosis of COPD
In older people structural changes involve the chest wall (stiffness due to changes in costovertebral joints), respiratory muscles (loss of mass), lung parenchyma (decrease in elastic recoil) and vasulature (increased stiffness of pulmonary vessels). The diagnosis of COPD, based on spirometry values, is a little different for the very elderly. For those below 70 years, the diagnosis of COPD can be considered if the FEV1 / FVC ratio is below 70 percent. For those above 80 years, COPD should be diagnosed only if FEV1/FVC ratio is below 60 percent.  COPD in non-smokers is more commonly seen in the elderly than in those who are young.

Pneumonia can present without fever in the elderly. A normal blood pressure in a hypertensive patient may be a cause for concern when the patient has pneumonia. Common causes of community acquired pneumonia in the elderly are pneumococci, H. influenzae, viruses, anaerobic bacilli (in those with swallowing difficulties) and gram-negative rods. During outbreaks of influenza, suspect Staph. aureus too. If the patient is a smoker or has chronic lung disease, Legionella should be considered as a possible cause. The mortality rate of pneumococcal pneumonia in the elderly is about 35%. 

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