Challenges in elderly care

In 2022, the share of global population aged 65 years and above was about 10%. The elderly are a rapidly growing population group and frequent users of healthcare services, which results in high per capita expenses [1] [2]. The modern way of life with high stress levels, unhealthy eating habits, lack of exercise and a sedentary lifestyle wreak havoc on the body. After seeing the cumulative consequences of years of unhealthy living since the unprecedented economic growth in the second half of the 20^th century, society has started to recognise the importance of preventive and home care. Prevention is also essential for the elderly, with much greater life expectancy than in the past. With technology enabling fast and effective prevention exams, some chronic and often debilitating conditions can be addressed much more effectively [3]. In this, an important role is played by practical, easy-to-use screening and diagnostic tools.

In this blog you will learn:

• What are the most common chronic conditions in the elderly?
• How to add not only years to life, but life to years?
• How to easily perform comprehensive health assessments in elderly care?

What are the most common chronic conditions in the elderly?

Hypertension

High blood pressure is defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. It is a very frequent medical condition. In 2010, around 31.3% of global population (or roughly 1 in 3 people on the planet) had hypertension [4]. Its prevalence increases with age, and it is estimated that up to 74% of individuals over the age of 80 have hypertension [5].

Hypertension is the most significant risk factor for cardiovascular disease (CVD), but can be successfully managed with lifestyle changes and antihypertensives [6] [7]. However, managing hypertension in the elderly is associated with challenges that are usually not present or are less frequent in other demographic groups. The pharmacokinetics and pharmacodynamics are altered, and patients may also suffer from other conditions like cognitive impairment, incontinence, fatigue, visual and auditory limitations, general frailty, and lack of social support and care [8] [9] [10] [11]. This is even worse when another cardiovascular risk factor is present and requires additional management.

Hypercholesterolemia

Again, the prevalence of hypercholesterolemia rises with age. This condition is another significant CVD risk factor. The patients, especially men, suffer higher rates of all-cause mortality [12] [13]. In 2008, 39% of adults worldwide had raised total cholesterol. Today, this number is much higher due to several factors, including greater awareness with subsequently higher diagnosis rates [14] [15]. Nevertheless, research shows that many patients with hypercholesterolemia remain undertreated and unmanaged [16]. Comprehensive treatment usually involves medications (most often statins) and lifestyle changes (smoking cessation, limiting alcohol intake, a healthy diet, and maintaining a healthy weight) [17]. Nevertheless, some widely used interventions may be ineffective in decreasing cholesterol levels in the elderly; a patient-centred approach is required. [18] [19] [20] [21]

Obesity

In 2016, it was estimated that at least 1.9 billion adults were overweight; more than 650 million of these were obese. The reasons for the current obesity epidemic in much of the developed and developing world are multifactorial and differ between regions. A lack of physical exercise and an abundance of (unhealthy) food are two major causes [22].

The health implications (particularly those associated with cardiovascular health) of obesity are many and serious, for the elderly demographic group and the rest of the population. Interestingly, some research has found evidence of an “obesity paradox” in the elderly: some individuals deemed overweight or obese may have better health outcomes than their normal weight or underweight counterparts with the same specific disease(s) [23]. Nevertheless, the elderly should still be as physically active as possible to mitigate the loss of muscle mass and combat frailty. In this, the type of exercise should be compatible with the patient’s fitness level and any other conditions [24].

Arthritis

Arthritis is certainly one of the diseases that interfere with physical exercise and can even prevent it  in severe cases. This is concerning as the prevalence of arthritis in the elderly is significant. Between 2010 and 2012, at least 52.5 million US adults (or 22.7% of all adult US population) were living with medically diagnosed arthritis [25]. The numbers were even higher in the 65-74 (41.6%), 75-84 (46.0), and 85+ (48.6%) age subgroups. These are percentages for men, but were even higher for women [25].

Of the aforementioned 52.5 million with arthritis, about 22.7 million had arthritis-attributable activity limitation. It was estimated that by 2040, at least 34.6 million US adults (of projected 78.4 million US adults with medically diagnosed arthritis) would have arthritis-attributable activity limitation [25]. However, arthritis is not only connected with impaired mobility; the patients (especially with rheumatoid arthritis) are also more at risk of developing CVDs, e.g. ischemic heart disease [26].

Coronary artery disease

Coronary artery disease (CAD), also known as ischemic heart disease (IHD), is the third most frequent cause of death and accounts for approximately 17.8 million deaths a year [27]. CVDs are the leading cause of global mortality and share many risk factors, including advanced age [28]; more than 60% of cardiovascular deaths occur in individuals aged 75 years or older [29].

It has been found that 31% of males and 25.4% of females over the age of 80 have CAD [30]. This is not surprising because many individuals in this age group present with concurrent medical conditions that are known risk factors for CAD. A very frequent one is diabetes [31].

Diabetes

There were 529 million individuals with diabetes worldwide in 2021. The growth of the number of diabetes cases is projected to rise [32], mostly for similar reasons as the number of CVD patients. The prevalence of diabetes (and prediabetes) is higher in the elderly population in comparison with younger demographic groups, and the elderly suffer worse outcomes and complications [33] [34] [35]. The most severe ones include diabetic foot ulcers (DFU) and chronic kidney disease (CKD) [36] [37].

Chronic kidney disease (CKD)

Diabetes is not the sole risk factor for the development of CKD, but certainly a prominent one: 30-50% of individuals with type 2 diabetes have CKD; those with type 1 diabetes represent a very small percentage [38]. Two other significant risk factors are hypertension (around 27.2% of cases) and primary glomerulonephritis [38].

In 2017, the global prevalence of CKD was estimated at 9.1% or 697.5 million of the global population. Regardless of its etiology, CKD is associated with many serious complications in all demographic groups. However, its prevalence is higher in the elderly, who often have other conditions, e.g. CVDs like heart failure, which make the treatment and management of CKD even more difficult [39] [40].

Heart failure

The global prevalence of heart failure (HF) is around 2% and is highly age-dependent. It affects less than 2% in individuals younger than 60 years, but can reach 10% or more in those older than 75 [41]. In addition to higher mortality rate, HF in the elderly correlates with cognitive decline, frailty, malnutrition, and a generally decreased quality of life with accompanying mental health issues like anxiety and depression [42] [43].

Depression

Difficulties with performing everyday tasks can take a toll on a person’s mental health, and the elderly are no exception. Many of them suffer from depression; a study estimated the global prevalence of depression in the elderly at 28.4%, but noted high variability between different regions [44].

Diagnosing and treating depression in the elderly is different from working with younger patients because depression manifests differently in this age group [45] [46]. Clinically, there is also a significant difference if the elderly person had depression earlier in life or became depressed in old age [45]. Some also simultaneously suffer from other psychiatric and neurological conditions like Alzheimer’s disease (AD) and dementia.

Alzheimer’s disease and dementia

Alzheimer’s disease (AD) can develop in younger individuals, but is far more common in those over the age of 65 [47]. It is currently the seventh most common cause of death worldwide. In 2020, it affected an estimated 50 million individuals.

Not only does AD it greatly reduce one’s life expectancy and quality of life [48] [49], but also hinders the treatment and management of the other conditions discussed here, as well as that of many others.

How to add not only years to life, but life to years?

Non-modifiable risk factors aside, prevention is key to healthy aging. An important aspect of prevention are timely and periodic check-ups and screenings, which can identify potential health issues at an early stage.

The goal of preventive medicine in the elderly is not just the reduction of mortality, but preserving the quality of life (the ability to function in everyday life without dependence on others for as long as possible) [50]. Due to the development of highly practical screening and diagnostic tools, prevention and other exams have become easier and therefore more accessible. Let us take a look at some tools that can be used at the GP’s office, at the elderly person’s home and/or in residential care.

How to perform comprehensive health assessments in elderly care?

Health care provision in residential settings (either at nursing homes or in home care) is connected with many advantages. A number of preventive and periodic check-ups can be performed in this way. Traditionally, complex diagnostic procedures could not be performed without transporting the patient to a healthcare facility; with technological progress, however, this has changed for at least a few diagnostic tests, including the ECG, which can now also be performed at home visits.

The MESI mTABLET is a portable, easy-to-use diagnostic system that features diverse diagnostic tools like the ECG, spirometry, ABI, TBI, pulse oximetry and blood pressure monitor for different types of blood pressure measurements available as apps. It also offers the Protocol app for faster examinations with custom protocols for preventive exams and patients with the same condition. Every measurement is automatically saved into the patient’s electronic record, and can be immediately shared with a remote GP or specialist.

Would you like to know more about MESI mTABLET in elderly care?