Heart Disease and the Elderly the Objective Essay

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Heart Disease and the Elderly

The objective of this work in writing is to examine how heart disease takes a toll elderly. Toward this end, this work will conduct a review of literature that examines the toll that heart disease takes on the elderly population.

Approximately 18 million people or 7% of all individuals in the United States have heart disease. Heart disease affects older people more significantly as the elderly are more likely, according to reports "to have coronary heart disease, commonly known as a heart attack or chest pain, which is more debilitating than other types of heart disease." (National Academy on an Aging Society, 2000) Many types of heart disease are largely, preventable through controlling high blood pressure and diabetes and engaging in a lifestyle that is healthy. While some individuals with heart disease do not have trouble on a daily basis the majority of those with heart disease are limited in normal activities and this includes in the area of work. The leading cause of premature permanent disability in the U.S. workforce is coronary heart disease. (National Academy on an Aging Society, 2000) The variations in the activity levels for those who do and those who do not have heart disease are reported as "substantial." (National Academy on an Aging Society, 2000) Adults with heart disease are reported as having more difficulties "with the activities of daily living, or ADLs, such as bathing, dressing, eating, using the toilet, walking, and getting into and out of bed." (National Academy on an Aging Society, 2000) These difficulties are reported to be more common among those in older age groups. Reports state that adults in the age range of 51 to 61 with coronary heart disease are about 1/3 of the group while adults older than 70 experience coronary heart disease at a rate of 50%. In fact, "the elderly have a higher rate of heart disease than any other group." (National Academy on an Aging Society, 2000) Furthermore, in older age groups "heart disease strikes more men than women." (National Academy on an Aging Society, 2000)

I. Heart Disease

Heart disease is "a type of cardiovascular disease." (National Academy on an Aging Society, 2000) Coronary heart disease is reported to be caused by "…a narrowing of the coronary arteries, which results in a decreased supply of blood and oxygen to the heart. CHD includes myocardial infarction, commonly referred to as a heart attack, and angina pectoris, or chest pain." (National Academy on an Aging Society, 2000) A heart attack results from the "sudden blockage of a coronary artery, usually by a blood clot. And chest pain occurs when the heart muscle does not receive enough blood." (National Academy on an Aging Society, 2000) Congestive heart failure is described as "the end-stage of heart disease." (National Academy on an Aging Society, 2000)

II. Heart Disease in the Elderly

Young (nd) reports that the elderly "represent the fastest-growing segment of the American population. By the year 2000, it is estimated that people over age 60 will account for more than 15% of U.S. citizens, those over 80 will constitute about 4%, or some 10 million Americans." (Young, nd) As a person becomes older the heart undergoes "subtle physiologic changes, even in the absence of disease. The muscles of the aged heart may relax less completely between beats; as a result, the pumping chambers (ventricles) become stiffer and may work less efficiently, especially if specific cardiac diseases are present. In old age, the heart also may not pump as vigorously or as effectively as it once did. The older heart also becomes less responsive to adrenaline and cannot increase the strength or rate of its contractions during exercise to the same extent it could in youth." (Young, nd) There is reported to be a great deal of variation in the rate of change or decline in cardiovascular function among individuals and it is stated for the healthy individual "the decline is not likely to be of great importance." (Young, nd) However, when another condition such as a valve disorder or coronary heart disease affects the heart the age-related changes may make the problem worse. The vascular system also undergoes changes with aging and the walls of the arteries are reported to have a tendency to "lose their elasticity and stiffen, even without internal blockage from fatty deposits." (Young, nd) This leads to a type of blood pressure that is common among older people or that of "isolated systolic hypertension." (Young, nd) As the individual age advances cardiovascular disease becomes more likely including coronary heart disease, hypertension, heart valve disease, and rhythm disorders." (Young, nd)

II. Types of Cardiovascular Disease More Common in the Elderly

The types of cardiovascular diseases, which are more common in the elderly, include the following:

(1) isolated systolic hypertension;

(2) Orthostatic hypotension;

(3) Heart failure;

(4) Aortic stenosis;

(5) Mitral annular calcification;

(6) Complete heart block;

(7) Complete heart block;

(8) Sick sinus syndrome;

(9) Atrial fibrillation;

(10) Stroke. (Young, nd)

III. High Blood Pressure in the Elderly

It is reported that high blood pressure is more common in the elderly as well as are the complications associated with high blood pressure including stroke, kidney disease, heart attack, and heart failure. By the time that individuals are seventy years of age nearly fifty percent of those individuals have hypertension generally reported by unknown causes. It is important that the elderly have regular blood pressure measures and treatment for levels that are above 160/90, which is stated to be high blood pressure levels. It is held historically that high blood pressure is a normal part of the aging process however, it has been reported more recently that hypertension in the elderly may be of concern as even in the elderly lowering elevated blood pressure saves lives. It is not possible to control hypertension in the elderly as easily as in younger individuals but partial treatment is reported to have the capacity to lower the rate of serious complications and this is backed by longitudinal scientific research studies. (Young, nd, paraphrased)

IV. Blood Pressure Treatment for the Elderly

Blood pressure treatment in the elderly should involve "a trial diet modification, moderate exercise and (if indicated) smoking cessation and weight loss" which is believed to be sufficient in lower blood pressure and reducing other associated risks. It is however stated that "highly restrictive or rigid programs of diet or exercise for the elderly are inadvisable and unlikely to succeed." (Young, nd) In the event that antihypertensive drug therapy is prescribed for the elderly individual it is likely that they will need to visit their doctor for regular checkups so that the results can be monitored properly. It is stated that some light-headedness or dizziness occurs in older people who have normal blood pressure which is a condition called orthostatic hypotension occurring when older people arise from a sitting or lying position. This is caused by a slowing down of the body in its reflexes that maintain the flow of blood from the heart to the brain and other organs. This tendency is often worsened when elderly take blood pressure medicine. Older patients are generally started with a low dose of medication with the dosage being increased on a gradual basis . Most elderly individual's blood pressure is lowered through a simple treatment regimen including small doses of diuretic or other beta or calcium channel blocker or ACE inhibitor. The other medications being taken by the patient is one consideration of the doctor in prescribing these types of medications as well as are the individual's other medical problems and even financial limitations. Another type of blood pressure more common in the elderly is that of 'isolated systolic ' hypertension which is a condition in which only the upper (systolic) reading is elevated. The systolic reading is reported to represent the "pressure exerted against the arterial walls when the heart contracts and pumps blood out" while the lower or diastolic number "represents the arterial pressure between heartbeats." (Young, nd)

V. Coronary Heart Disease

Coronary heart disease is reported as the number one killer in elderly individual with nearly half of all heart attack victims being over 65. Men have more heart attacks than women do however, after menopause the rates of coronary heart disease for women rise to equal the rate of coronary disease in men. Heart disease prevention is focused on "premature heart disease -- blockage of the coronary arteries that occurs in middle age." (Young, nd) Coronary heart disease has always been held to be a natural part of aging however, this has been most recently to be shown as a false belief and it is reported that in some cultures "…in which the average blood cholesterol and blood pressure is lower than in many industrialized societies, the prevalence of coronary heart disease among the elderly is not nearly as great." (Young, nd) Coronary heart disease in the elderly is stated to potentially manifest as "reversible episodes of myocardial ischemia,…

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