Altered responses to illness in the elderly

https://www.physio-pedia.com/Older_People_-_Patterns_of_Illness,_Physiological_Changes_and_Multiple_Pathology

Good Practice

Distinguishing the accumulation of age related disease (morbidity) from true ageing is difficult. An
important aspect of management of older adults is to recognise and understand how body systems are
interlinked. Awareness of pathological and normal age-related physiological changes will assist your
assessments and help you decide on best management of older people.

Firstly, the reader is forbidden to approach this section with a feeling of impending doom. Secondly,
remember that not everyone experiences all mentioned issues, and those with disabling conditions have
often accommodated to the changes without too much of an impact on their lifestyle.

In earlier life, the signs and symptoms of illness might be explained by a single diagnosis. In older people,
the number of active or inactive pathological processes might compromise both the precise diagnosis as
a basis of treatment, and include or be impacted on by a further disability. Hence awareness of different
pathological processes and of normal age-related physiological changes will assist your assessment and
management of older people.

Illnesses often present differently in old age than in youth. Regulation of body temperature is unstable
or less responsive, so pyrexia may not be as marked as would be expected even in severe infections such
as pneumonia, appendicitis or pyelonephritis. The converse, a lack of awareness of cold, or of the
capacity to react normally to it, may lead to hypothermia.

Altered responses
Delirium is characterised by an acute, fluctuating change in mental status with inattention and altered
levels of consciousness. Categories include hyperactive delirium, characterised by agitation and visual
hallucinations, as opposed to hypoactive delirium characterised by lethargy and withdrawal.
Precipitating factors including immobility, malnutrition, intercurrent illness, dehydration and, stress of
admission to hospital or other unfamiliar settings[2].

Pain is common in older people. However as people age, they complain less of pain. The reason may be
a decrease in the body's sensitivity to pain or a more stoical attitude toward pain. Some older people
mistakenly think that pain is an unavoidable part of aging and thus minimise it or do not report it. Even
in conditions that cause intense pain in earlier life (e.g. angina or fractures), there may be so little
discomfort, or pain is referred in such a bizarre way, that diagnosis is delayed – sometimes with fatal
consequences. Pain is often not correctly recognised and treated in people with dementia, and use of a
scale such as the Abbey pain scale may help to recognise when a person is in pain.

Response to drugs also alters with age (see section on Medication).

Recovery from illness is often slower, owing to inter-current infections or to the debilitating nature of
the condition. Conversely, some old people may make remarkable and quite unexpected recoveries
from severe mental or physical impairment.

Further Reading

The following article provides some perspective into different aspects of frailty and co-morbidity, some
exploring the functional impact of these issues.

British Pain Society. Webpage@ http://www.britishpainsociety.org/

Cigolle C et al (2009). Comparing Models of Frailty: The Health and Retirement Study. J Am Geriatr Soc;
57; 830–839

Fries J (1980). Aging, natural death and the compression of morbidity. New Eng J of Med; 303; 130 - 135

Guralnik J, Ferruci L, Balfour J, Volpato S, di Iorio a (2001). Progressive versus catastrophic loss of the
ability to walk: Implications for the prevention of mobility loss. Journal of the American Geriatric Society;
49; 1463 - 70

Patrick L, Knoefel F, Gaskowski P, Rexroth D (2001). Medical Comorbidity and rehabilitation efficiency in
geriatric inpatients. Journal of the American Geriatric Society; 49; 1471 – 1477

Pain in older people: Reflections and experiences from an older person’s perspective. Help the Aged
publication accessed online at: http://www.britishpainsociety.org/book_pain_in_older_age_ID7826.pdf

The Further Reading box below lists conditions often seen in the older population. It is not exhaustive,
and as you gain more experience, your knowledge about the conditions will increase. Relevant
information and facts about these conditions can be found in textbooks that specialise in the clinical
areas listed. Alongside some conditions or categories are dedicated UK websites of the organisations
that support their cause. Remember there will be differences in prevalence and presentation depending
on the country you are from.
Further Reading

The NHS Choices website has a section on conditions and treatments – Health A – Z. The site describes
some common conditions with tabs that links to real patient stories as well as symptoms, causes,
diagnosis, treatments etc http://www.nhs.uk/Conditions/Pages/hub.aspx

Health Talk Online (Dipex) is a charity that uses a website to share information about patient
experiences across all sorts of health care areas. You can see stories related to diagnosis, activity etc by
clicking on the A - Z conditions tab. http://www.healthtalkonline.org/

Orthopaedic conditions – see the National Osteoporosis Society www.nos.org.uk and the Arthritis
Research Council www.arc.org.uk websites for information on conditions such as osteoporosis and
osteomalacia, fractures – especially femoral and humeral necks, Colles and vertebral fracture, Paget’s
disease, Osteoarthritis and Rheumatoid arthritis

Neurological conditions include Cerebro-vascular disease - see The Stroke Association site at
http://www.stroke.org.uk/index.html; Parkinson’s disease - see Parkinson's UK site
http://www.parkinsons.org.uk/default.aspx in particular in the 'Professional's section; Neuropathies and
other such neurological conditions can be accessed through the National Institute for Neurological
Disorders and Stroke site at http://www.ninds.nih.gov/index.htm

General medical conditions - search health data-bases or look on e-medicine sites such as
http://www.emedicinehealth.com/diabetes/article_em.htm. Diabetes, Falls, Diverticulitis and Irritable
Bowel Syndrome, Carcinomas, Incontinence, Urinary tract infections, Hernia – especially hiatus, Renal
failure

Cardiorespiratory conditions - information through the British Heart Foundation at

http://www.bhf.org.uk/ and lung conditions at the British Lung Foundation at http://www.lunguk.org/ .
Include ischaemic heart disease, congestive cardiac failure, pneumonias and chronic obstructive
pulmonary diseases

Psychological conditions. If the mental health problem is related to a long-term physical condition e.g.
stroke, rheumatoid arthritis, you may find information in a source about the medical condition. If the
issue is purely of a mental health origin, look up a specific mental health resources e.g. Depression;
Dementia at Alzheimer's at http://alzheimers.org.uk/ , Lewy body disease at http://www.lewybody.org/,
and dementia UK at http://www.dementiauk.org/
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References

Izaks G and Westendorp R (2003). Ill or just old? Towards a conceptual framework of the relation
between ageing and disease. BMC Geriatrics, 3(7). www.biomedcentral.com/1471-2318/3/7

Elie M, Cole MG, Primeau FJ, Bellavance F (1998). Delirium Risk Factors in Elderly Hospitalized Patients. J
Gen Intern Med; 13(3): 204–212