Which of the following is the most common chronic health problem in late adulthood?

Breathe 2006 3: 40-49; DOI: 10.1183/18106838.0301.40

Abstract

Key points

• The ageing of the population has increased the prevalence of chronic diseases, which represent a huge proportion of human illness.

• The two most important risk factors underlying the most frequent chronic diseases of the elderly are tobacco use and obesity.

• The most important comorbidities are cardiovascular diseases and chronic respiratory diseases, particularly COPD.

• Comorbidities may not only contribute to the severity of a patient's clinical manifestations, but they may also complicate its treatment, and they are therefore important to recognise and treat effectively.

Educational aims

• To increase the interest of chest physicians in multiple chronic comorbidities in the elderly.

• To define the most important and frequent comorbidities in elderly patients, particularly those with COPD.

• To provide updated information on the most common chronic diseases present in the elderly.

• To emphasise the limitations of single disease-oriented clinical practice guidelines, and the need for a more comprehensive “internistic” approach to patients with multiple chronic comorbidities.

• To suggest that chronic inflammation might represent the common pathogenetic link between the different chronic diseases present in the elderly.

Summary Elderly people are often affected by two or more chronic diseases, more frequently cardiovascular diseases, chronic respiratory diseases, metabolic syndrome and cancer. These most frequent chronic diseases share largely preventable risk factors, the most important being smoking and obesity, and may be linked to chronic systemic inflammation. Coexisting chronic diseases affect the course of the primary disease and alter the efficacy and safety of its management. Current clinical practice is dominated by the "singledisease" approach, which has major limitations, and there is increasing evidence that a patient-oriented approach that takes into account the several co-existing components of chronic disease is required. This "change of concept" implies the need for medical specialists to extend their expertise to broader diagnostic and treatment approaches that are traditionally the purview of internal medicine. This new approach also requires a different approach to clinical research and teaching, followed by extensive rewriting of medical textbooks and remodelling of teaching curricula to reflect the complexity of the patient affected by chronic diseases.

• ©ERS 2006

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