When we talk about patient aging, there are variations from individual to individual based on their genetics and their lifestyle, and healthcare patterns. When we speak about age-specific medical issues, where generally speaking about ages 70 and over. But to elaborate, aging is a very widespread issue. It affects all aspects of medical care. It affects the underlying pathophysiology. It also affects issues of presentation and the full spectrum of management issues.
It affects medications and choices for devices and surgery for individual patients. Even our thoughts about outcomes are different. Rather than focusing only on mortality type of outcomes. We’re worried about the quality of life, about recurrent hospitalizations, and even end-of-life issues.
When we speak about our population of older adults, there are currently more than 55 million patients aged 65 and over. Those numbers are expected to grow by 70 million by 2030. So, when we talk about the aging population, this is a population that is particularly predisposed to cardiovascular disease. The role of cardiologists is especially important. They should be better tuned to healthcare for this expanding population of vulnerable elderly.
ECCOA or Essentials of Cardiovascular Care in Older Adults was developed with a grant from the John Hartford foundation. Particularly today, with the population’s aging, were all acting for the people in their 90’s. the practice of geriatric cardiology or cardiology is the same for older and younger adults.
However, aging does change the playing field. The care of the older frail adult is not so straightforward. These older patients require more thought and consideration. One of the most important age-associated changes in physiology occurs to all of us as we get older, and this sort of change is the playing field. Therefore, we start to see syndromes in older adults including systolic hypertension, heart failure with normal systolic function, syncope, and sick sinus syndrome.
As we get older, we also change the way that we metabolize drugs. So, the doses that we might’ve used in younger people can cause problems in older people because of changes in renal and hepatic functions and volume of distribution. Don’t forget that many older people are already on several other drugs as well.
Then take into account that many of these older folks have geriatric symptoms including frailty; some might be cognitively impaired or have caregiver stress. So, when we talk about the care of the older patient, we’re turning our focus to patient-centric care.
Cardiology is focused on intensive care to cure disease while geriatrics often is more protective with an emphasis on doing more harm. Cardiology embraces drugs and devices as being good while geriatrics often have a healthy skepticism that drugs may be dangerous. Cardiology is evidence-based and geriatrics is emphasizing much more on patient-centered care. So, in combining perspectives from both clinical disciplines, we can better appreciate a more comprehensive approach to older adults with cardiovascular disease.
This is particularly important where evidence is less robust or where individual health preferences or health states may vary. In this particular category, we do not want to reiterate what the fellows and doctors already know but also emphasize aspects of cardiology where age is relevant.
The simple goal to follow when you take part in essentials for cardiovascular care in older adults is to raise awareness of age-specific changes and how they impact cardiovascular disease assessment and management. Next is to appreciate the evidence-based care of adults and to identify gaps in our knowledge. Finally, to reduce morbidity and mortality through the best and most informed individualized care.