ADDRESSING THE UNIQUE HEALTHCARE NEEDS OF ADULTS OVER 65

Medically Reviewed by Dr. Sony Sherpa (MBBS) - October 17, 2023

Elderly people possess unique healthcare requirements that demand careful consideration from medical professionals. Those aged 65 and older often contend with the challenges of aging, enduring chronic health conditions, and facing functional limitations. Consequently, their healthcare regimen must encompass a range of vital components, including routine screenings for early disease identification, effective medication management for the complexities of multiple prescriptions, proactive preventive care to avert severe disease complications, empathetic psychosocial support to address the mental health facets associated with aging, and specialized care coordination to ensure their well-being.

Age-related Changes

Our bodies naturally experience a number of degenerative changes as we age. These changes are an intrinsic part of the aging process and are driven by various factors, including apoptosis, telomere damage, the accumulation of free radicals within the body, and the influence of external damaging agents.

Cognitive Changes in Older Adults

Cognitive alterations are a common occurrence in adults aged 65 and above. These cognitive changes can be attributed to age-related transformations in the neurons of the brain and often manifest as:

• Mental Fog: Older individuals may experience a sense of mental fog or cognitive cloudiness, making it harder to think clearly and efficiently.
• Memory Loss: Memory decline is a typical feature of aging, with older adults often encountering challenges in remembering and recalling information.
• Slowing of Learning Capacity: The learning capacity tends to diminish with age, making it more difficult for older individuals to acquire new knowledge and skills.

It is essential to differentiate between the normal cognitive changes associated with aging and early signs of dementia. While age can bring about a decline in certain cognitive abilities such as memory, attention, and processing speed, more severe forms of functional impairment may warrant attention and further investigation to rule out dementia.

Physical Changes in Older Adults

As we age, our bodies undergo noticeable physical changes, including:

• Decreased Muscle Mass: Older adults typically experience a reduction in muscle mass, leading to decreased strength and mobility.
• Reduced Regenerative Power: The body's ability to repair and regenerate tissues diminishes with age, making it harder to recover from injuries and illnesses.
• Lower Bone Density: Older adults often face a decline in bone density, which can increase the risk of fractures and osteoporosis.
• Joint Mobility Reduction: Mobility in the joints decreases over time, making movements less flexible and more uncomfortable.
• Cartilage Wear and Tear: Cartilage within the body wears down, resulting in joint discomfort and stiffness.
• Skin Changes: Loss of elastic tissue in the skin contributes to developing wrinkles.
• Hair and Hormonal Changes: Men may experience hair loss, while women undergo post-menopausal changes due to declining estrogen levels.

Sensory Changes in Older Adults

Sensory changes frequently impact the lives of older adults, affecting various aspects of their well-being:

• Visual Impairments: Older individuals commonly experience visual impairments, including senile cataracts and near-sightedness, which can impair their ability to see clearly.
• Hearing Loss: Sensorineural hearing loss is another sensory change that can occur in older adults, making it challenging to hear and communicate effectively.

Increased Prevalence of Chronic Conditions

As adults reach the age of 65 and beyond, they often find themselves grappling with the development of chronic health conditions. It becomes increasingly important to take measures aimed at preventing complications associated with these conditions. Hypertension, or high blood pressure, is a common concern in older adults. Uncontrolled hypertension can have serious and protracted effects on cardiovascular health, emphasizing the significance of meticulously monitoring blood pressure as people age.

Moreover, advancing age is also a risk factor for diabetes. It becomes essential to monitor and control blood sugar levels to reduce any potential health hazards related to diabetes. Osteoarthritis is another condition that tends to emerge with age, affecting joints and often resulting in pain and discomfort. It is critical to address the symptoms and limits of this disorder because it can significantly affect a person's overall quality of life.

Chronic kidney disease and chronic obstructive pulmonary disease (COPD) are additional chronic health issues that may develop as individuals grow older. These conditions require ongoing attention and management to ensure they do not progress to more severe stages, which could significantly impact an older adult's health and well-being.

The presence of multiple chronic conditions underscores the complexity of healthcare management for adults over 65. An integrated approach to healthcare is essential in addressing these conditions comprehensively. This includes effectively managing chronic pain and discomfort resulting from these ailments, with a focus on improving the individual's overall comfort and quality of life.

Medication Management

Many elderly people face multiple health challenges, leading them to rely on various prescribed medications. Recent research reveals a concerning trend: a growing number of people aged 65 and older are taking more than three different medications. This increase can be attributed to advancements in the pharmaceutical industry, resulting in a complex medication regimen for many older adults. Pharmacists play a vital role in averting polypharmacy through medication therapy management, educating patients, supporting deprescribing efforts, and advocating for appropriate drug use.

Drug Interactions

One significant challenge associated with taking multiple medications is the risk of drug interactions. When individuals juggle several medicines, the likelihood of these drugs affecting each other increases. For instance, combining common antihypertensive ACEI (Angiotensin-Converting Enzyme Inhibitors) with sulphonylurea-class anti-diabetic drugs can lead to severe hypoglycemia and dizziness, illustrating the complexity of managing multiple medications.

Age-Related Physiological Changes

Age-related physiological changes further complicate medication management. Elderly individuals often experience a slowdown in drug metabolism due to factors such as reduced liver mass, diminished hepatic blood flow, decreased enzyme activity, and compromised drug clearance stemming from reduced renal function and renal diseases. These factors collectively elevate the risk of drug toxicity in this demographic.

Medication Management Challenges

Moreover, elderly individuals frequently encounter challenges related to medication management. Memory loss, hearing impairments, and vision issues can impede their ability to adhere to medication instructions accurately. Consequently, they become more susceptible to both drug-related adverse effects and medication errors. Managing medications in older individuals necessitates a meticulous, customized approach that takes into account these unique challenges.

A Holistic Approach to Polypharmacy

Comprehensive medication reviews are essential, especially for drugs like statins, anticholinergics, benzodiazepines, antipsychotics, and proton pump inhibitors, which are often prescribed without clear indications. Regular evaluations enable a detailed examination of the risks and benefits of these drugs. To facilitate this process, guidelines have been established, offering evidence-based recommendations on medications to avoid in the elderly. These guidelines provide justifications for usage, assess the quality of evidence supporting each recommendation, and assign a graded strength to the recommendation.

Care Coordination and Healthcare Team

A multidisciplinary healthcare team is essential to take care of adults over 65. Depending on the disease history, the team may require a cardiologist, a nephrologist, a pulmonologist, an endocrinologist, and a gastroenterologist. Such a team is particularly needed in adults with several severe comorbidities.

A coordinated and multidisciplinary healthcare team can help to optimize health, reduce unwanted drug interactions, and address multiple diseases simultaneously. Multi-system diseases warrant teamwork by specialists from different fields of healthcare.

Preventive Care and Screenings

When it comes to diseases, prevention is always preferred to treatment. It is critical to take preventative measures to lower the chance of major illnesses. Engaging in regular physical exercise is beneficial for lowering the risk of cardiovascular and musculoskeletal diseases. Alongside this, maintaining control over your diet and managing risk factors, such as high blood sugar levels, can significantly contribute to disease prevention.

For older adults, there are specific vaccines recommended to prevent severe illnesses. These include vaccines for pneumonia, influenza, shingles (herpes zoster), and tetanus booster shots.

Another crucial aspect of healthcare for individuals over 65 is regular screening for age-related conditions. Early disease detection can help delay irreversible complications and facilitate treatment. Screening for various types of cancer is essential:

• Breast Cancer: Women should undergo mammograms and breast examinations to detect breast cancer. Self-examination for detecting lumps at home is also recommended, along with tumor marker tests when necessary.
• Prostate Cancer: Men can have blood tests to detect prostate cancer, with prostate-specific antigen levels serving as an indicator. Symptoms like difficulty urinating may also warrant attention.
• Colon Cancer: Older adults should consider sigmoidoscopy or colonoscopy to detect colon cancers. Fecal occult blood tests can also identify the presence of blood in feces.
• Lung Cancer: Individuals with a history of significant smoking should undergo screening for lung cancer, which may involve imaging studies such as X-rays or computed tomography scans of the chest.

Other conditions prevalent in elderly individuals, like osteoporosis and increased heart attack risk in post-menopausal women due to estrogen decline, require specific evaluations. A DEXA scan is recommended for assessing bone health, while various imaging tests, functional assessments, and blood workups may be necessary for issues related to bones, ligaments, tendons, and muscles.

Screening for diabetes and hypertension can be done through simple blood tests or measurements. Additionally, cholesterol levels, including low-density lipids and high-density lipids, should be screened regularly. If an unfavorable lipid profile is detected, it should be managed to reduce the risk of strokes, heart attacks, and ischemic diseases. For a comprehensive health assessment, ultrasound examinations of the abdomen are recommended for older adults. This can identify conditions such as abdominal aneurysms, gall bladder masses, and other potential health issues.

Addressing Functional Limitations

The general health and wellbeing of people aged 65 and older can be greatly impacted by functional restrictions.  Addressing these limitations is crucial to improve their quality of life.

• Mobility Challenges: Osteoarthritis and joint mobility problems are primary contributors to functional limitations in older adults. Additionally, wear and tear on cartilage, tendons, and ligaments can restrict movement and hinder engagement in physical activities. Muscle-related issues and the loss of muscle mass also play a role in limiting mobility.
• Preventing Falls: Falls are a major concern for elderly individuals, as even minor falls can lead to serious injuries, especially in frail individuals or those with underlying metabolic or bone conditions. To prevent falls, it is essential to promote proper lower limb mobility, optimize foot care, and take precautions such as avoiding slippery surfaces, maintaining good posture while moving, and wearing appropriate footwear.
• Assistive Devices: There are various assistive devices available to help individuals with mobility challenges regain their independence. These include mobility aids, grip-strengthening tools, joint support bands, and other assistive devices. These devices can greatly benefit those with functional limitations, allowing older adults to maintain their independence with minimal assistance.

Psychosocial and Mental Health Support

Older adults often face various mental health challenges, underscoring the importance of tailoring the healthcare system to meet their unique psychosocial support and mental health facility requirements. These challenges encompass:

• Social Isolation-Related Issues: Social isolation can give rise to a range of mental health problems in older adults. To help them cope effectively, specialized healthcare services are essential. Encouraging group activities that promote mental well-being and social interaction can play a vital role in preventing such problems. Additionally, therapy may be necessary to provide guidance and support.
• Bereavement and Grief Management: Anxiety and despair may result from the death of friends and loved ones, which can have a significant effect on older adults. Proper grief management approaches are crucial in these situations. Counselors can provide valuable assistance in navigating the grieving process. In more severe cases, medication might be considered as part of the treatment plan.
• Other Mental Health Issues: Age-related mental decline can give rise to various mental health conditions. Dementia and Alzheimer's disease, in particular, can significantly impede an older adult's ability to function independently. It is imperative for the healthcare system to address these unique needs effectively, providing comprehensive care and support tailored to the specific challenges posed by these conditions.

Conclusion

Creating specialized healthcare services tailored to adults over 65 is of utmost importance. Healthcare providers should receive specialized training in age-specific care in order to properly address the special needs of this age group. Older adults often grapple with the challenges associated with aging, chronic illnesses, and managing multiple medications. Therefore, it is crucial to offer comprehensive multi-specialty care that is customized to address each individual's specific requirements.

Furthermore, it is essential to support older adults in maintaining their mobility, reducing functional limitations, and providing tailored mental or psychosocial assistance. Preventive care and regular screening tests should be emphasized as a key aspect of healthcare for this age group. By focusing on prevention, we can help older adults lead healthier, more fulfilling lives while managing the effects of aging and chronic diseases effectively.

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References:

• Boss, G R, and J E Seegmiller. “Age-related physiological changes and their clinical significance.” The Western journal of medicine vol. 135,6 (1981): 434-40.
• Kim, Luke D et al. “Medication management in older adults.” Cleveland Clinic journal of medicine vol. 85,2 (2018): 129-135.
• Bulpitt, C J et al. “Should medical screening of the elderly population be promoted?.” Gerontology vol. 36,4 (1990): 230-45.
• Reynolds, Charles F 3rd et al. “Mental health care for older adults: recent advances and new directions in clinical practice and research.” World psychiatry : official journal of the World Psychiatric Association (WPA) vol. 21,3 (2022): 336-363.

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