There are many types of thyroid disease. The main conditions present in most thyroid illnesses are hypothyroidism (thyroid under activity) and hyperthyroidism (thyroid over activity). Thyroid problems are more common in older women than in men. Thyroid patients require life-long monitoring.  Hyperthyroid patients often feel unusually nervous or irritable. Hypothyroid patients can feel unusual fatigue or depression. It is important for thyroid patients and their families to understand that these reactions are common and likely to resolve with treatment. It is also important to realize that some thyroid disorders develop very gradually and it can take a while before they disappear after treatment has been initiated. Since symptoms may not be easily recognized at first, subtle reactions in emotions or behaviour may be the only visible signs of thyroid disorder.

References

  1. Thyroid Foundation of Canada.  Retrieved March 10, 2014 from: 
    http://www.thyroid.ca/know_the_facts.php

The most common thyroid problems in older people are hypothyroidism, hyperthyroidism and thyroid nodules. (1)

Why is it important?

  • Thyroid diseases are very much the diseases of older people and often are not properly diagnosed
  • 4% of older people may have undiagnosed hypothyroidism and 2% have unsuspected hyperthyroidism
  • Thyroid problems are more common in older women than in men:  female to male ratio 10:1 (2)
  • Clinical examination of women is complicated by the changes in posture and anatomy brought on by thinning of the bone or osteoporosis
  • Calcified thyroid nodules can cause much discomfort and can appear as rock hard masses or lumps in the chest and be misidentified as metastases of cancer from the breast or stomach that have spread to the lymph glands or the neck.

Common Causes

  • The most common cause of hypothyroidism (or under activity) in older people is Hashimoto's Thyroiditis. It results in an enlargement of the thyroid gland, caused by an autoimmune condition
  • The most common cause of hyperthyroidism is Plummer's Disease. It is characterized by a bumpy, lumpy enlarged thyroid with nodules that are overactive.

Key Considerations

  • In hypothyroidism,  signs include:
    • Abnormalities in the cerebellum at the back of the brain which leads to an ataxic or drunken gait;
    • Aches and pains that are not in or around the joints - rheumatism that is not arthritis;
    • Carpal Tunnel Syndrome - a compression of an important nerve to our hand in the wrist causes tingling sensations which can be corrected without surgery.
  • With hyperthyroidism 3/4 of older patients present atypically; 1/3 are clinically euthyroid (have no external symptoms of thyroid dysfunction) while 15% have a syndrome called Apathetic Thyrotoxicosis, a form of hyper-thyroidism which in fact looks like hypothyroidism.
  • In both conditions there will be a failure to thrive, confusion, depression, falling, walking disturbances, incontinence from immobility, heart failure and change of bowel habits (either constipation or diarrhea). Not only do these signs make it difficult to distinguish hyper from hypothyroidism in the elderly, they are, in fact, the signs of many other common illnesses of older people.
  • The TSH level is the most accurate indicator of thyroid function and is an even better test than direct measurement of thyroid hormone in the bloodstream.
  • Signs and symptoms of hypothyroid  include: weak slow heart beat; muscular weakness and constant fatigue; sensitivity to cold; thick puffy skin and/or dry skin;  slowed mental processes and poor memory; constipation; goiter (increased size of the thyroid)
  • Signs and symptoms of hyperthyroidism include:  rapid forceful heartbeat; tremor; muscular weakness; weight loss in spite of increased appetite; restlessness, anxiety and sleeplessness; profuse sweating and heat intolerance; diarrhea; eye changes and goiter (increased size of the thyroid)

References

1.  Thyroid Foundation of Canada.  Retrieved March 10, 2014 from: 
      http://www.thyroid.ca/

2.  Tahboub, R.  Thyroid Dysfunction in the Elderly.  Retrieved March 2014 from: 
      http://www.naama.com/pdf/thyroid-dysfunction-in-elderly-rund-tahboob-md.pdf

Chronic kidney disease (CKD) means that your kidneys are diseased or damaged in some way, or are ageing and not working as well as they once did. Severity can vary but most cases are mild or moderate, often occur in older people, do not cause symptoms and generally do not progress to kidney failure. Although about half of people aged 75 or more have some degree of CKD, most of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys. People with any stage of CKD have an increased risk of developing heart disease or a stroke. It is important to detect even mild CKD, as treatment may not only slow down the progression of the disease, but also reduce the risk of developing heart disease or stroke.(1)  A routine blood test is commonly done to detect kidney disease and monitor people with conditions that can affect the kidneys, such as diabetes or high blood pressure.

References

1.  Patient.co.uk.  Retrieved March 2014 from: 
     http://www.patient.co.uk/health/chronic-kidney-disease-leaflet

There is an age-related decline in kidney function; however, not all individuals will develop chronic kidney disease (CKD) with advancing age.  Those who are genetically predisposed and exposed to lifetime cardiovascular risk factors are likely to develop systemic atherosclerosis and CKD. (1)

Why is it Important?

  • 70.9% of people with CKD have hypertension compared with 20.1% of people without CKD (1)
  • About 1 in 10 people have some degree of CKD and it is more common in women (2)
  • CKD contributes to poor health through its association with inflammation and oxidative stress (1)
  • Malnutrition, weight loss and sarcopenia are common in CKD patients, leading to poor outcomes, such as physical and cognitive dysfunction, manifesting as major geriatric syndromes (1)
  • Frailty is likely to be one of the underlying processes that leads to the clinical manifestations of geriatric syndromes in patients with CKD (1)
  • Functional outcomes, such as cognition and physical functioning, are more relevant outcomes to older patients with CKD (1)
  • Renal function declines physiologically with advancing age and pathologically as a result of associated diabetes mellitus and hypertension (1)
  • Although about half of people aged 75 or more have some degree of CKD, most of these people do not actually have diseases of their kidneys; they have normal ageing of their kidneys  (2)

Key Considerations

  • Interventions should be developed and assessed in terms of maintaining quality rather than quantity of life in order to prevent disability (1)
  • Investigations to exclude treatable kidney disease (e.g. urinary tract infection or obstruction) (2)
  • Reduce progression of kidney disease (by controlling BP to recommended levels with ACEI or ARB therapy) (2)
  • Reduce cardiovascular risk, avoidance of nephrotoxic medications and volume depletion, Lipid-lowering treatment, glycemic control (2)
  • Early detection and management of CKD complications by: avoid renally-excreted medications; adjust medication doses for kidney function and appropriate referral to a nephrologist where indicated (2)

References

1.  Abdelhafiz, A., Ahmed, S., El Nahas, M. & Flint, K.  (2011).  Is chronic kidney disease in older people a new
     geriatric giant? Aging Health, October 2011, Vol. 7, No. 5, Pages 749-762.  Retrieved March 10, 2014 from:
     http://www.medscape.com/viewarticle/753447

2.  Phoon, R. (2012) Chronic kidney disease in the elderly: Assessment and management.  Australian Family
     Physician Volume 41, No.12, December 2012 Pages 940-944. Retrieved March 2014 from:
     http://www.racgp.org.au/download/Documents/AFP/2012/December/201212phoon.pdf

Chronic respiratory diseases are ongoing diseases of the airways and other parts of the lung. Some of the most common diseases are asthma, chronic obstructive pulmonary disease (COPD), lung cancer, sleep apnea and work related exposure leading to lung disease(s). These chronic diseases have a major impact on an individual’s quality of life and also on family life, the community, and the health care system. (3) 

As individuals age, the lung tissue and air sacs can become weaker and lose elasticity, putting the older person at higher risk of: lung infections, such as pneumonia and bronchitis, shortness of breath, lower oxygen levels, (reducing the body's ability to fight diseases) and abnormal breathing patterns, which can lead to problems such as sleep apnea (episodes of stopped breathing during sleep). (2)

Complications from the flu can lead to pneumonia in the elderly and may result in hospitalization. In the elderly, the flu vaccine helps prevent pneumonia and hospitalization in 6 out of 10 people and can prevent death in 8 of 10 people.(1) The Pneumococcal vaccine is recommended for all adults 65 years of age and older, and for individuals less than 65 years of age in long-term care homes who have chronic health conditions or who are immunocompromised (have weakened resistance to disease as a result of medications or a disease process).(3)

Contact your health care team to discuss what steps you can take to manage or slow the progress of the disease

References

1.   KFL&A Public Health Unit (2014). Retrieved May 2014 from:
      http://www.kflapublichealth.ca/Files/Resources/166_what_you_should_know_about_influenza.pdf

2.   Medline Plus (2014).  Retrieved  May 2014 from:
      http://www.nlm.nih.gov/medlineplus/ency/article/004011.htm

3.   Public Health Agency of Canada. (2013).   Chronic Respiratory Diseases.  Retrieved March 14, 2014 from:
      http://www.phac-aspc.gc.ca/cd-mc/crd-mrc/index-eng.php

Respiratory diseases affect individuals of all ages, however as individuals age, lung function deteriorates as a result of a number of physiological changes which can lead to reduced lung function and capacity. Ventilatory lung function deteriorates about 2 times faster after age 50 yr.  Dyspnea, the subjective experience of breathlessness has been identified as the sixth vital sign.(3)

Chronic respiratory diseases have a major impact not only on the individual with the disease, but also the family, the community, and the health care system. Some of the most common chronic diseases in the elderly are chronic obstructive pulmonary disease (COPD) which includes emphysema and/or chronic bronchitis, lung cancer, sleep apnea and lung disease(s) as a result of occupational hazards or exposure. The true prevalence of COPD is underestimated because a diagnosis is often not made until the patient is over 55 years of age.

The two most important risk factors for chronic respiratory diseases are tobacco smoke (through smoking and/or exposure to second-hand smoke) and indoor and outdoor air quality. Those who smoke cigarettes increase their risk of developing lung cancer, chronic obstructive pulmonary disease (COPD) and asthma.(2)  Complications from influenza can lead to pneumonia in the elderly and may result in hospitalizationand even death.(1)

Why is it important?

  • Most individuals with COPD are not diagnosed until the disease is well advanced. The true prevalence of COPD is underestimated because a diagnosis is often not made until the patient is over 55 years of age and has advanced changes in the lung tissue.(3)
  • While COPD was once more common in men than women, it is now on the rise in women.(4) 
  • In 2000/2001, COPD was the seventh most common cause of hospitalization for men and the eighth most common cause of hospitalization for women, in Canada. COPD was the 4th leading cause of hospitalization in Ontario.  Hospitalizations were greater for patients over 65 years of age.(2)
  • Chronic obstructive pulmonary disease, along with influenza and pneumonia, were the most common causes of death due to respiratory diseases among Canadian seniors in 2006. There are higher mortality rates for individuals over 75 yr. as a result of COPD.(2)
  • Canadian health care costs for COPD represent an enormous burden. The three major lung diseases namely lung cancer, asthma and COPD, cost $12 billion in 2010, including $3.4 billion in direct health-care costs (drugs, hospitals, physicians) and $8.6 billion in indirect costs (such as premature death and long term disability).(2)
  • Smoking is less prevalent among seniors than among the younger population, with 9% of Canadians aged 65 years and older being current smokers (either daily or occasional) and 47% being former smokers. Smoking is much more common among Aboriginal seniors, with 24% of those age 65 years and older not living on a reserve, being daily smokers. (2)
  • Seniors are more at risk for serious complications if they contract influenza which can lead to hospitalization and/or death.(1)

Key Considerations

    • Early recognition of exacerbation of lung disorders and symptom management is key to the prevention of frequent hospitalization and possible acute respiratory failure.
    • Clinicians need to support and reinforce the individuals’ disease self-management strategies.(3)
    • Spirometric testing should be performed to target and establish early diagnosis in at risk individuals.(3)
    • Individuals with COPD often experience an imbalance between energy intake and expenditure despite a normal diet.
    • Individuals with COPD generally have increased energy expenditure to breathe which results in increased caloric intake needs. Protein depletion is a common feature of COPD.(3)
    • Annual influenza vaccination is recommended for individuals over 65yr. and for individuals less than 65 years of age in long-term care homes who have chronic health conditions or who are immunocompromised. There is a 70% reduction in mortality from influenza following vaccination.(2)
    • Current practice advocates pneumococcal vaccine for high risk individuals. The vaccine has efficiency in COPD patients of up to 65% (2)
    • An interprofessional approach will best support the individual with chronic respiratory disease.

References

1.   Ontario Ministry of Health and Long-Term Care.  (2008).  About the Flu.  Retrieved March 14, 2014 from:
      http://www.health.gov.on.ca/en/public/programs/publichealth/flu/about_flu.aspx

2.   Public Health Agency of Canada. (2013).   Chronic Respiratory Diseases.  Retrieved March 14, 2014 from:
      http://www.phac-aspc.gc.ca/cd-mc/crd-mrc/index-eng.php

3.   Registered Association of Nurses of Ontario. (2010). Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with
      Chronic Obstructive Pulmonary Disease (COPD)
.  Retrieved May 2014 

4.   Statistics Canada. (2011). Retrieved May 2104 from:
      http://www.statcan.gc.ca/pub/82-625-x/2010002/article/11273-eng.htm

The heart is a muscle that gets energy from blood carrying oxygen and nutrients. Having a constant supply of blood keeps the heart working properly. Most people think of heart disease as one condition. But in fact, heart disease is a group of conditions affecting the structure and functions of the heart and has many root causes.

Coronary artery disease develops when a combination of fatty materials, calcium and scar tissue (called plaque) builds up in the arteries that supply blood to your heart (coronary arteries). The plaque buildup narrows the arteries and prevents the heart from getting enough blood. Heart disease is preventable and manageable by controlling the risk factors that could lead to coronary artery disease, such as high blood pressure, high cholesterol, diabetes, smoking, stress, excessive alcohol consumption, physical inactivity and being overweight.

When diagnosed with a heart condition, there are treatments to help manage the illness. The goal is to reduce risk by considering these heart-healthy steps: be smoke-free; be physically active; know and control your blood pressure; eat a healthy diet that is lower in fat, especially saturated and trans fat; achieve and maintain a healthy weight; manage diabetes; limit alcohol use; reduce stress and follow your health care provider’s advice.

Heart Attack Warning signs

Warning signs can vary from person to person and they may not always be sudden or severe.  Some people will not experience chest pain at all, while others will experience only mild chest pain or discomfort. Others may experience one symptom, while some experience a combination.
•   Chest discomfort (uncomfortable chest pressure, squeezing, fullness or pain, burning or heaviness)
•   Discomfort in other areas of the upper body (neck, jaw, shoulder, arms, back)
•   Shortness of breath • Sweating • Nausea • Light-headedness 

Stroke

A stroke is a sudden loss of brain function. It is caused by the interruption of flow of blood to the brain (ischemic stroke) or the rupture of blood vessels in the brain (hemorrhagic stroke). The interruption of blood flow or the rupture of blood vessels causes brain cells (neurons) in the affected area to die. The effects of a stroke depend on where the brain was injured, as well as how much damage occurred. A stroke can impact any number of areas including your ability to move, see, remember, speak, reason, read and write.

Stroke is a medical emergency. Recognizing and responding immediately to the stroke warning signs by calling 9-1-1 or your local emergency number can significantly improve survival and recovery.

In a small number of cases, stroke-like damage to the brain can occur when the heart stops (cardiac arrest). The longer the brain goes without oxygen and nutrients supplied by blood flow, the greater the risk of permanent brain damage. Brain injuries can also result in uncontrolled bleeding and permanent brain damage. This is usually referred to as an Acquired Brain Injury. When someone has a stroke, the functions that are affected depend upon which area of the brain was damaged and how much damage occurred.

Stroke can be treated. That's why it is so important to recognize and respond to the warning signs.

•  Weakness is a sudden loss of strength or sudden numbness in the face, arm or leg
•  Sudden difficulty speaking or understanding or confusion even if temporary
•  Sudden trouble with vision
•  Sudden severe and unusual headache
•  Sudden loss of balance, especially with any of the above signs
•  Dizziness

References

  1. Heart & Stroke Foundation.  Retrieved March 2014 from: 
    http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.2796497/k.BF8B/Home.htm   

Cardiovascular disease (heart disease and stroke) is a leading cause of death for Canadian men and women.  The more risk factors you have, the greater your risk. When certain risk factors occur together, known as metabolic syndrome, the risk of heart disease, stroke, and diabetes becomes greater.

Why is it important?

  • Older individuals are at greater risk; most strokes occur in people over 65.
  • Men over the age of 55 and postmenopausal women are at greater risk of heart disease.
  • Until women reach menopause they have a lower risk of stroke than men.
  • Risk of heart disease is increased if close family members – parents, siblings or children – developed heart disease before age 55 or, in the case of female relatives, before menopause.
  • Risk of stroke is increased if close family members – parents, siblings or children – had a stroke before age 65.
  • First Nations people and those of African or South Asian descent are more likely to have high blood pressure and diabetes, and therefore are at greater risk of heart disease and stroke than the general population.
  • Persons who had a previous stroke or a TIA, which is also known as a mini-stroke, your risk of stroke increases.
  • Manageable risk factors: high blood pressure (hypertension) ; high blood cholesterol ; diabetes; being overweight; excessive alcohol consumption ; physical inactivity ; smoking; stress  

Heart attack warning signs

  • Warning signs can vary from person to person and they may not always be sudden or severe.  Some people will not experience chest pain at all, while others will experience only mild chest pain or discomfort. Others may experience one symptom, while some experience a combination.
  • Chest discomfort (uncomfortable chest pressure, squeezing, fullness or pain, burning or heaviness)
  • Discomfort in other areas of the upper body (neck, jaw, shoulder, arms, back)
  • Shortness of breath • Sweating • Nausea • Light-headedness 

Why is it important?

  • Stroke can be treated. It is important to recognize and respond to the warning signs.
  • Weakness is a sudden loss of strength or sudden numbness in the face, arm or leg
  • Sudden difficulty speaking or understanding or confusion even if temporary
  • Sudden trouble with vision
  • Sudden severe and unusual headache
  • Sudden loss of balance, especially with any of the above signs
  • Dizziness

Ischemic stroke:  About 80% of strokes are ischemic caused by the interruption of blood flow to the brain due to a blood clot. The buildup of plaque (fatty materials, calcium and scar tissue) contributes to most ischemic strokes by narrowing the arteries that supply blood to the brain, interfering with or blocking the flow of blood. This narrowing is called atherosclerosis. An ischemic stroke is either "thrombotic" or "embolic."

Thrombotic strokes are caused by a blood clot that forms in an artery directly leading to the brain. Embolic strokes occur when a clot develops somewhere else in the body and travels through the blood stream to the brain.

Transient Ischemic Attack (TIA) also known as a "mini-stroke" is caused by a temporary interruption of blood flow to the brain. The symptoms (warning signs) are similar to an ischemic stroke except they go away within a few minutes or hours. Many people can have a TIA without even knowing it. A TIA is an important warning sign that puts you at increased risk of a full-blown stroke.

References

  1. Heart & Stroke Foundation.  Retrieved March 2014 from: 
    http://www.heartandstroke.com/site/c.ikIQLcMWJtE/b.2796497/k.BF8B/Home.htm   

“Cancer is a disease that starts in body cells. Our bodies are made up of millions of cells, grouped together to form tissues and organs such as muscles and bones, the lungs and the liver. Genes inside each cell order it to grow, work, reproduce and die. Normally, our cells obey these orders and we remain healthy. But sometimes the instructions get mixed up, causing the cells to form lumps or tumours, or spread through the bloodstream and lymphatic system to other parts of the body.

Tumours can be either benign (non-cancerous) or malignant (cancerous). Benign tumour cells stay in one place in the body and are not usually life-threatening.

Malignant tumour cells are able to invade nearby tissues and spread to other parts of the body. Cancer cells that spread to other parts of the body are called metastases.

The first sign that a malignant tumour has spread (metastasized) is often swelling of nearby lymph nodes, but cancer can metastasize to almost any part of the body. It is important to find malignant tumours as early as possible.” (1)

References

1.  Canadian Cancer Society.  Retrieved March 2014 from: 
     http://www.cancer.ca/en/cancer-information/cancer-101/what-is-cancer/?region=on

Cancer is a disease that mostly affects Canadians aged 50 and older. Cancers are named after the part of the body where they start. For example, cancer that starts in the bladder but spreads to the lung is called bladder cancer with lung metastases. Cancer is the leading cause of death in Canada and is responsible for about 30% of all deaths.

Why is it important?

  • An estimated 187,600 new cases of cancer and 75,500 deaths from cancer will occur in Canada in 2013.
  • The number of estimated new cases does not include 81,700 new non-melanoma skin cancer cases.
  • 96,200 Canadian men will be diagnosed with cancer and 39,400 men will die from cancer.
  • 91,400 Canadian women will be diagnosed with cancer and 36,100 women will die from cancer.
  • On average, over 500 Canadians will be diagnosed with cancer every day.
  • On average, over 200 Canadians will die from cancer every day.
  • Lung, breast, colorectal and prostate cancer are the most common types of cancer in Canada (excluding non-melanoma skin cancer). Based on 2013 estimates: these cancers account for over half (52%) of all new cancer cases.
  • Prostate cancer accounts for about one-quarter (26%) of all new cancer cases in men.
  • Lung cancer accounts for 14% of all new cases of cancer.
  • Breast cancer accounts for about one-quarter (26%) of all new cancer cases in women.
  • Colorectal cancer accounts for 13% of all new cancer cases.
  • Across Canada, cancer incidence rates vary because of differences in the type of population, risk  factors (including risk behaviours) and early detection practices.  Similarly, rates of cancer death vary because cancer screening rates and the availability and use of treatment vary across the country.
  • Survival rates vary from low to high depending on the type of cancer and other factors.  For example, based on 2006–2008 estimates: The 5-year relative survival rate for
    •   lung cancer is low (17%).
    •   colorectal cancer is average (65%)
    •   prostate cancer (96%)
    •   breast cancer (88%)

References

  1. Canadian Cancer Society.  Retrieved March 2014 from: 
    http://www.cancer.ca/en/cancer-information/cancer-101/what-is-cancer/?region=on

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