Age and aging

Graham Jackson
Consultant Cardiologist, Guy’s and St Thomas’ Hospitals NHS Trust,
Cardiothoracic Centre, St Thomas’ Hospital, London, UK
Correspondence: Dr Graham Jackson, Guy’s and St Thomas’ Hospitals NHS Trust, Cardiothoracic Centre, 6th Floor East Wing, St Thomas’ Hospital, Lambeth Palace Road, London SE1 7EH, UK. Tel: +44 20 7928 9292, fax: +44 20 7960 5680, e-mail: lilian.crossley@gstt.sthames.nhs.uk

Health care of the elderly assumes ever-increasing importance in developed countries as their populations age. With age come serious illnesses and increased health care utilization with important cost implications and the danger of practicing ageism. Currently, worldwide, there are 380 million people aged over 65 years of age, but by 2020 this figure will have risen to 690 million, and deaths due to noncommunicable diseases (mainly cardiovascular) will have risen to an overall figure of 49.7 million from the current 28 million. The challenge of managing cardiovascular disease in the elderly is important now, but can only increase over time.
Cardiovascular risk increases with age, whether due to age alone or combined with an increased incidence of diabetes, hypertension, or, to a lesser degree, hyperlipidemia. As a result of a greater overall risk, the potential for greater overall benefit from risk factor modification has become a reality in the elderly.
Social factors are important. Women live longer than men and therefore more often live alone and, in turn, are lonely. The elderly have more concerns about money and may rely on less healthy foods and spare themselves everyday conveniences such as proper heating. In an increasingly violent society the elderly become more vulnerable and may be afraid to go out and exercise, and, in turn, show a greater reluc-tance to give up smoking, which becomes their indoor recreation. Our medical advice must therefore be coupled with community action. There is a need to improve the financial circumstances of the elderly, to improve their environment (indoors and outdoors), and to promote good health with easily accessible and tailored healthy lifestyle options which are safe to pursue.
In this issue we are promoting cardiovascular health, and, importantly, putting age and health in perspective. Age may alter myocardial oxidative metabolism, but as Professor Gropler concludes, we need to know the exact relevance to the elderly in the clinical context because of the potentially important therapeutic implications. The alterations in cardiac metabolism are reviewed by Professor van der Vusse, and these also have implications for general advice and prescribing. Safe prescribing in the elderly is an important issue because of the changes in physiology and pharmacology that occur with age, so the paper by Drs Wisniacki and Lye has great practical relevance. Angina in the elderly is common, and in my article I have tried to balance risk over benefit, taking into account the needs and wishes of the individual.
Christopher Blauth brings a surgeon’s perspective to selecting patients for surgery. The risks rise with age, so the selection process must be individualized to that particular person’s risk. The patient’s family also needs to be aware of the risks as well as the benefits – fully informed consent is an essential part of our medical practice. In addition, full agreement between surgeon and cardiologist must be the key to optimizing management, so a surgeon’s view is to be welcomed. Dr Meurin highlights the problem of treating high-risk patients and, in discussing the management, emphasizes the role of the metabolic agent trimetazidine as a means of avoiding haemodynamic side-effects while relieving symptoms and improving quality of life. Collectively in this issue the authors put quality of life at the forefront of our approach to treating elderly patients with cardiac disease.
We can only do so much for the elderly as health care professionals: the elderly also need committed politicians, who will support the social infrastructure, and strong family carers. The elderly do not want to be a burden nor should they be. The community, both medical and nonmedical, owes them that right.