Clinical: A Quick Reference Guide to Common Conditions in Older Adults

A Quick Reference Guide to Common Conditions in Older Adults

Osmosis Team
Published on Oct 23, 2023. Updated on Oct 24, 2023.

Diagnosing common conditions is vital to providing effective care and sustaining a high quality of life for all patients, but it's especially important as patients age. In today's Osmosis by Elsevier blog, we're exploring some of the common conditions that present as we grow older.

In the coming decades, the world’s aging population is expected to climb to more than two billion. As each of us grows older, age-related physiologic changes, as well as pathologic conditions, may develop. Common physiologic changes may include hearing loss and skin lesions, along with common pathologic conditions like pitting edema and back pain.

Let’s take a closer look at some of these common conditions. 

Hearing Loss

There are a variety of types of hearing loss, and age-related hearing loss, known as presbycusis, is one of the most common. It is a type of sensorineural hearing loss that develops over time, usually in both ears. It initially presents as the loss of the ability to hear high-frequency sounds (e.g., birds chirping) and can make it difficult to engage in conversation. 

The cause of presbycusis is multifactorial. However, in general, it’s due to age-related degeneration of structures in the ear like the acoustic nerve; hair cells in the cochlea; and the stria vascularis, which is the part of the cochlea that helps maintain the composition and level of fluid in the inner ear.

Diagnosis of presbycusis begins with an audiometry exam and audiogram that typically shows loss of the ability to hear high-frequency sounds. While there’s no cure for presbycusis, hearing aids can help maintain quality of life and the ability to engage in conversation by amplifying sound waves.  It can also be helpful for affected individuals to avoid things that can further damage the structures involved in hearing, like muffling loud noises, by wearing ear protection and adhering to treatment plans for comorbid conditions like hypertension and diabetes mellitus.

Skin Lesions

Some skin lesions are normal as individuals age, like solar lentigos, also known as age or liver spots; and cherry angiomas, also known as senile angiomas.

Solar lentigos are flat, round, dark brown or black lesions that are non-painful and typically found on the face, back of the hands, or other areas that have high amounts of ultraviolet (UV) and sun exposure. UV exposure can cause the proliferation of melanocytes, a type of cell that produces pigment; and the accumulation of melanin, the pigment produced by melanocytes.

On the other hand, cherry angiomas are small, pinpoint, red lesions that commonly appear on the torso, arms, and legs. Although the cause of cherry angiomas isn’t fully understood, they commonly develop in individuals as they age, giving rise to the colloquialism ‘senile angiomas.’

Both solar lentigos and cherry angiomas are non-cancerous and can be easily diagnosed through history and physical examination. Typically, there is no need to treat either condition as they are benign and cosmetic in nature. 

Pitting Edema

One of the pathologic conditions commonly seen in older adults is pitting edema, which is swelling that results from the accumulation of excess fluid. When pressure is applied to the area, an indentation, or pit, typically remains visible. It may affect any part of the body, though typically occurs in the legs, feet, and ankles. It can be dependent, meaning gravity pulls blood downwards, causing fluid to pool; or peripheral, as a result of fluid retention in peripheral tissues. 

In older adults, pitting edema is commonly caused by conditions like congestive heart failure; kidney disease (e.g., nephrotic syndrome); and venous insufficiency. It can also be the side effect of certain medications like antihypertensives, used to treat high blood pressure, or non-steroidal anti-inflammatory drugs (NSAIDs), used to treat conditions like mild pain caused by osteoarthritis. 

Diagnosis and treatment of pitting edema are the same, no matter the individual's age.  It is typically diagnosed clinically, but certain lab tests, like albumin levels, and diagnostic imaging, like ultrasound, can aid in identifying the underlying cause. Treatment involves addressing any underlying condition and may include things like diuretic medications to remove excess fluid or compression stockings to promote circulation.

Back Pain

Lastly, back pain is common in older adults, especially in the form of a condition called facet arthropathy, which is swelling and tenderness of the facet joints in the spine that normally allow for bending, twisting, and alignment. Facet arthropathy most commonly affects the lumbar spine but can also affect the cervical spine. It usually presents as back or neck pain that is dull and worsens with movement but improves when leaning forward. The pain can sometimes radiate to the arms or legs. 

Facet arthropathy in older adults is typically caused by age-related wear and tear on the facet joints; and can be made worse by obesity; poor posture; repetitive stress, like sitting for long periods of time; and the presence of comorbid conditions, like osteoarthritis

Diagnosis and treatment of facet arthropathy in older adults is similar to treatment at any age. Diagnosis begins with a history and physical examination and may include diagnostic imaging tests like X-rays, CT scans, or MRIs. Treatment options typically consist of NSAIDs, heat, and ice to help manage the pain; and maintain functional ability through physical therapy. For severe cases, injections or surgery may be considered.

See also:Auditory ossicles; Skin cancer; Congestive heart failure; Spinal disc herniation; Skin anatomy and physiology; Osteoarthritis

About the Author

Kelsey LaFayette, DNP, ARNP, FNP-C, obtained a Bachelor of Arts in Nursing degree from Luther College in 2011. As an RN, she has a clinical background in medical and pulmonary inpatient units, urgent care, and critical care, and obtained her Doctor of Nursing Practice degree at the University of Illinois at Chicago in 2022. Throughout her career, Kelsey has had many opportunities to function in an education role by being a charge nurse, preceptor to new RNs and nursing students, as well as a Clinical Team Lead in charge of creating orientation programs and policies. Through these opportunities, Kelsey realized her ideal career path should focus on the education of nurses, nursing students, patients, families, and anyone else with a desire to learn. Kelsey serves as a manager on the Nursing Content team and has been able to work on various projects that fulfill her love of perpetual learning.


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