Asthma is common among persons over age 65 and can cause serious health problems. In fact, most deaths caused by asthma occur in this age group. The disease accounts for huge health care costs among older adults each year. Yet asthma is often missed or goes untreated among this age group.
Although these facts are changing, asthma remains an important cause of illness and death among older adults. This article explains some of the reasons why. It also offers information on how asthma among older adults differs from the illness in younger age groups.
How Common Is Asthma in Older Adults?
To learn about how common certain diseases are among the U.S. population, the Centers for Disease Control and Prevention conducts the National Health Interview Survey on a regular basis. In 1994, asthma was reported among an estimated 14.5 million persons in the United States. Of these, more than 1.5 million, or about 10 percent, were age 65 or over. Within this age group, asthma was reported in nearly one-third more women than men. And at all ages, the chance of having asthma is greater among blacks than among whites.
A 1997 study found that older patients with asthma had more unscheduled visits to their doctors' offices and to emergency rooms. They also were more likely than younger patients to be hospitalized for asthma. Another 1997 study found that the length of hospital stays for asthma increased as patients grew older. It also found that older asthma patients were more likely than younger patients to enter convalescent and nursing homes after they were discharged from the hospital.
How Is Asthma Different Among Older Adults?
Most persons with asthma have their first symptoms at a young age. But asthma may first appear at any age, even in a person's 70s or 80s. When asthma does develop at an advanced age, the symptoms are much like those among young adults. One way in which asthma differs at older ages, though, is that greater amounts of medication are needed to maintain normal breathing in older patients.
Asthma can be more dangerous in older adults because they are more likely to develop respiratory failure, even during mild attacks. One study found that older patients with mild asthma attacks had the same level of breathing trouble as younger asthma patients with severe attacks. Further, unlike the illness in younger persons, asthma in older adults rarely goes into remission. Rather, it is more likely to remain a severe and disabling disorder.
Why Is Asthma Hard to Diagnose in the Older Adults?
A diagnosis of asthma may be missed in an older person because other health problems may mask the disease. In particular, heart disease and emphysema (another respiratory illness that causes breathing problems) are more common in this age group. The symptoms of illnesses such as these can be similar to those of asthma. This is why the signs and symptoms of asthma may not be identified right away. It is also why asthma may go untreated.
Another reason why asthma can be hard to spot among older adults has to do with their lifestyles. Older persons are more likely to have inactive lifestyles. Part of the reason for this is because health problems that prevent physical activity are more common with age. One of the ways in which asthma is recognized among younger persons is by the symptoms of wheezing and breathing problems during and after exercise. But if a patient rarely exercises, the opportunity for asthma to produce these symptoms may rarely arise.
Asthma symptoms among older adults are more likely to take the form of coughing and producing sputum (fluid) from the lungs. Health care providers are more likely to interpret symptoms like these as being due to other illnesses, such as chronic bronchitis (inflammation of the upper airways) or congestive heart failure (in which the heart has trouble pumping enough blood).
What Are Some Treatment Problems Among Older Adults?
Treatment of asthma in older adults can be complicated by the fact that so many older persons take multiple medications for other health problems. Asthma medications can react with these other treatments, causing unpleasant side effects. In addition, other medications may worsen asthma symptoms.
Older patients are more likely than younger patients to have mental confusion and memory problems. This may be the result of normal aging or of an illness such as Alzheimer's disease. Whatever the cause, these problems can make it hard for an older patient to follow treatment instructions. This can be especially true if, like many older persons, the patient receives several types of medications for different health problems.
In addition, many asthma medications come in the form of an inhaler. Using an inhaler requires a certain degree of coordination and dexterity. The patient must press down quickly on the inhaler while drawing in a short, deep breath. Older persons are more likely to have conditions such as arthritis, which affects physical movement and coordination. These patients may find it more difficult to use inhalers properly in order to receive the correct dose.
Treatment with oral medications can help older asthma patients avoid problems with inhaler use. Short courses of oral steroids are helpful to treat acute asthma flares. Long-term oral steroid treatment is usually avoided in older asthma patients. Over time, oral steroids can cause severe side effects, such as weakening of bones, ulcers and high blood pressure.
Talk With Your Doctor
As with any asthma patient, treatment for older adults should be a joint decision between patient and doctor. Communication is the key to making treatment work. Older asthma patients should be sure to ask their doctor about any aspect of their asthma treatment that they do not understand. Keeping the doctor informed about how well treatment is working for them is important. Patients need to tell their doctor if they are having trouble remembering to take their medication or if they are having difficulty using devices such as inhalers. Their doctor is an important resource to help them keep their asthma under control so that their later years are as comfortable and healthy as possible.
SOURCE: This information should not substitute for seeking responsible, professional medical care. First created 1995; fully updated 1998; most recently updated 2005.
© Asthma and Allergy Foundation of America (AAFA) Editorial Board