Essentials of cardiovascular care for older adults: extending a US-based educational resource for collaboration with our China colleagues

Throughout most of the world, people are living substantially longer. As a result, there is a rapidly expanding population of older adults who did not previously survive into old age. These adults are exposed to advanced aging processes that did not previously occur. Physiological changes of age predispose to cardiovascular diseases. Ironically, coronary heart disease, heart failure, valvular heart disease, peripheral artery disease, arrhythmias and other cardiovascular problems all soar with survival into senior years. Geriatric cardiology is a relatively new area within cardiology that is culling skills and insights to address the complex needs of older cardiovascular patients. The rationale for “geriatric cardiology” is that cardiovascular disease among older adults often differs substantially from cardiovascular disease in younger populations. Risk factors, presentation, and management are all transmuted by age, such that an effective clinician must have unique insights and skills to provide optimal care for his or her aged patients. Furthermore, clinical targets may also shift with age. Whereas increased longevity is a dominating priority when providing care for younger adults, many older cardiovascular patients may also prioritize physical function, symptomatic improvement, independence, quality of life, and other clinical objectives. Geriatric cardiology entails skills of communication, risk assessment, physical examination, and treatment commensurate with the needs of the older cardiovascular patient. Distinctive age-related clinical challenges include non-specific signs and symptoms, barriers to communication (e.g., auditory and visual impairments), limited patient access to care, altered pharmacokinetics and dynamics, frailty, sarcopenia, multimorbidity, polypharmacy, and cognitive decline. A geriatric cardiologist must provide effective care amidst such complexity, including sensitivities and skills to achieve therapeutic strategies that are tailored to each patient’s individual circumstances. Geriatric cardiology entails regular engagement with each patient to make sure that therapeutic goals are synchronized with his or her priorities, since these preferences may change over time or with onset of an illness. 2 The development of essentials of cardiovascular care for older adults