Focus on treating just the heart jeopardizes health of elderly in cardiac intensive care units

By Sarah MooreDec 9 2019

Medical professionals at the American Heart Association have announced that there is a pressing need to change how elderly patients in cardiac intensive care units are treated. While they may receive excellent care for heart conditions, they are also likely to suffer from any number of age-related conditions, which can go under the radar or be overshadowed by their heart problem.

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Most studies into recovery from heart conditions conducted on younger patients

Heart attacks occur, on average, once every 40 seconds in the US. Those who are most likely to suffer one are those in the elderly population, given that the average age of a first heart attack in men is 65.6 years old, and 72 for women.

However, clinical trials that have investigated the best practices for treating acute cardiovascular conditions have mostly focused on younger patient groups. Therefore, their findings may not apply to older patients. A recent announcement by the American Heart Association has supported this suspicion.

It has been found that while cardiac intensive care units may provide outstanding care to elderly patients in terms of treating their heart condition, they may be failing these older patients in terms of treating their other geriatric conditions, which can worsen as a result of hospitalization and heart treatment.

Frailty can worsen, and cognitive function can decline following the admittance to cardiac intensive care units, often due to the multiple medications required for their heart treatment and the long-time spent immobilized in bed.

The fact that most research into treating patients for heart conditions has been limited to studying younger populations means that treating the often related geriatric conditions of elderly patients have been left out of consideration. However, treating the whole patient, rather than the specific heart condition is essential to increasing treatment success for all patients, but particularly for the elderly.

Whilst being treated in an acute cardiovascular care unit, elderly patients are experiencing conditions such as bright lighting, new medications, stress from noise, sleep disturbances, dietary changes, and more, which can be a pressure on their psychological wellbeing.

Younger patients are less likely to be severely impacted by these changes, and this is why their impact has been underestimated. For older patients who are more likely to be already suffering from cognitive decline, these circumstances can be significant to their overall health.

A holistic approach to healthcare

The American Heart Association recommends that it is essential to consider the whole person when it comes to effective healthcare. While a patient may be hospitalized primarily because of a heart condition, this does not mean that this is the only health concern they are affected by. They suggest that patient age should inform clinicians on how to tailor treatment to make it more suitable to the person.

For instance, early mobilization of elderly patients is key to addressing the increased frailty of older people. While younger populations may cope with being in bed for an extended period while recovering from a heart problem, an older patient may become increasingly frail as a result of inactivity. Therefore, it is recommenced that appropriate physical movement should be encouraged from the earliest point possible.

Further to this, medication dosage should be considered carefully given that side effects may be more potent for elderly people. On average, a patient admitted to cardiac intensive care units are prescribed a total of 12 medications, this increases the chances of adverse side effects and drug-drug- and/or drug-disease interactions, which can be particularly challenging for those experiencing cognitive decline.

The protocol for prescribing elderly patients medications should include close monitoring of their response, which may lead to discontinuation of certain drugs as is seen to be appropriate.

The American Heart Association hopes that the integration of geriatric syndromes into cardiovascular care for older patients will become widespread, to improve the level of care that this group receives. The holistic care approach will likely become increasingly adopted, improving the quality of life and prognosis for elderly patients.