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Word of the Day

Nearly one third of elderly have dyspnea with exertion

Clinical Question:
How common is dyspnea among the elderly?

Bottom Line:
Nearly 36% of people older than 65 years report dyspnea with modest degrees of effort. (LOE = 2a)

Reference:
van Mourik Y, Rutten FH, Moons KG, Bertens LC, Hoes AW, Reitsma JB. Prevalence and underlying causes of dyspnoea in older people: a systematic review. Age Ageing 2014;43(3):319-326.  [PMID:24473156]

Study Design:
Systematic review

Funding:
Self-funded or unfunded

Setting:
Population-based

Synopsis:
The authors searched MEDLINE for 2 kinds of studies: (1) studies that, among other things, used the Medical Research Council dyspnea severity scale on people older than 65 years from the general population who did not have acute dyspnea ; and (2) studies that assessed the causes of dyspnea in the elderly. The authors don't describe the process of study inclusion. Since no standard tools exist to assess the quality of prevalence studies, the authors adapted elements from the standards for other study types to develop their own. They found 21 reports of the prevalence of dyspnea and its severity (19,185 elders) and only one study reporting on its etiology (555 elders). Overall, the researchers had few concerns about the quality of the included studies. After pooling their data, they reported that 36% of elders report dyspnea when hurrying on level ground or walking up a slight hill; 16% experience dyspnea when walking slowly on level ground; and 4% report having to stop to catch their breath after walking 100 yards (or a few minutes) on level ground. The authors further report that the prevalence increases with advancing age and that women were more likely to report dyspnea than men. Since only one study reported on the etiology, the data are not terribly robust, but they can serve as a starting point. By the way, these data are vulnerable to the limitations of the availability heuristic. Heuristics are mental shortcuts humans use, usually unconsciously, to simplify complex information. The availability heuristic can play out in several ways, one of which is to link a recent diagnosis to subsequent information. This can lead to premature anchoring. For example, if a patient recently hospitalized for pneumonia seen a few days after discharge reports worsening dyspnea since changing to the oral antibiotics, the availability heuristic might lead to a change in antibiotic therapy (premature anchoring on the pneumonia) rather than trigger a worry about the potential for a pulmonary embolism or other cause of the change in status. Anyway, these authors presume that the finding of a diagnosis that COULD cause dyspnea is the explanation for THAT person's dyspnea. Only 19% of the patients had cardiac explanations for the dyspnea, 42% had pulmonary conditions, and 9% had both. In 12% of persons, they could find no explanation.

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