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Disorders in Older People

By Richard W. Besdine, MD, Professor of Medicine, Greer Professor of Geriatric Medicine, and Director, Division of Geriatrics and Palliative Medicine and of the Center for Gerontology and Healthcare Research, Warren Alpert Medical School of Brown University

(See also Overview of Aging.)

Some disorders occur almost exclusively in older people. They are sometimes called geriatrics syndromes (geriatrics refers to the medical care of older people).

Other disorders affect people of all ages but may cause different symptoms or complications in older people. The following are some examples:

  • Underactive thyroid gland (hypothyroidism): Usually, younger people gain weight and feel sluggish. In older people, the first or main symptom may be confusion.

  • Overactive thyroid gland (hyperthyroidism): Usually, younger people become agitated and lose weight. In contrast, older people may become sleepy, withdrawn, depressed, and confused.

  • Depression: Usually, younger people become tearful, withdrawn, and noticeably unhappy. Sometimes older people do not seem unhappy. Instead, they become confused, forgetful, and listless, lose interest in their usual activities, or seem lonely.

  • Heart attack: Usually, younger people have chest pain. Older people may not have chest pain but may have difficulty breathing or abdominal pain. They may sweat profusely, suddenly feel tired, pass out, or become confused.

  • Abdominal perforation: An organ in the digestive tract, such as the stomach or intestine, occasionally tears (perforates), causing widespread serious infection in the abdominal cavity. Usually, younger people have severe abdominal pain and fever, and the abdomen feels tight. In contrast, older people may have none of these symptoms. Instead, they may become confused or feel very weak.

The confusion that these disorders cause in older people is often mistaken for dementia.

Older people often have more than one disorder at a time. Each disorder may affect the other. For example, depression may make dementia worse, and an infection may make diabetes worse.

However, disorders no longer have the same devastating or incapacitating effects that they once had in older people. Disorders that were once likely to result in death for older people, such as heart attacks, hip fractures, and pneumonia, can often be treated and controlled. With treatment, many people with chronic disorders, such as diabetes, kidney disorders, and coronary artery disease, can remain functional, active, and independent.

Some Disorders That Affect Mainly Older People



Memory and other mental functions are progressively lost.

The wall of the aorta bulges. If untreated, an aneurysm can rupture and lead to death.

Atrophic urethritis and vaginitis

Tissues in the urethra thin, sometimes causing burning during urination. Tissues in the vagina thin, sometimes causing pain during intercourse.

The prostate gland enlarges, blocking the flow of urine out of the bladder.

The lens of the eye clouds, impairing vision.

The body does not respond to the insulin it produces. This disorder may begin during middle age. Treatment with insulin may not be required.

The optic nerve is damaged because pressure in part of the eye is elevated. Vision is progressively reduced, and blindness can result. Glaucoma usually begins during middle age.

The cartilage that lines the joints degenerates, causing pain. Osteoarthritis usually begins during middle age.

Bones become less dense and more fragile. As a result, fractures are more likely.

Nerve cells in the brain degenerate slowly and progressively, causing tremor, stiff (rigid) muscles, and difficulty moving and maintaining balance.

The skin breaks down because prolonged pressure reduces blood flow to the affected area.

Cancer develops in the prostate gland and eventually interferes with the flow of urine.

The chickenpox virus from an earlier infection is reactivated, causing blisters and sometimes long-lasting, excruciating pain.

A blood vessel in the brain is blocked or ruptures. A stroke causes symptoms such as weakness or loss of sensation on one side of the body, problems with vision in one eye, difficulty speaking or understanding, loss of balance or coordination, or sudden severe headache.

The flow of urine cannot be controlled, resulting in leakage.

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