Treating rhinitis in the older population: special considerations
Raymond G Slavin
Abstract
Rhinitis in the elderly is a common but often neglected condition. Structural changes in the nose associated with aging, predisposes the elderly to rhinitis. There are a number of specific factors that affect medical treatment of the elderly including polypharmacy, cognitive dysfunction, changes in body composition, impairment of liver and renal function and the cost of medications in the face of limited resources. Rhinitis in the elderly can be placed in several categories and treatment should be appropriate for each condition. The most important aim is to moisten the nasal mucosa since the nose of the elderly is so dry. Great caution should be used in treatment with first generation antihistamines and decongestants. Medications generally well tolerated by the elderly are second generation antihistamines, intra-nasal anti-inflammatory agents, leukotriene modifiers and iprapropium nasal spray.
Rhinitis is a common and bothersome condition in the elderly. Despite its importance, little attention is paid in the general medical literature. In the most recently published highly regarded geriatric text, rhinitis is not included in the index whereas rhinophyma is. The number of Americans older than 65 years of age will increase from 35 million to 86 million by the year 2050. While the exact number of elderly patient with rhinitis is not known, it is believed that 40% of the general population experiences nasal symptoms. It would be safe to say that the many changes that occur in the connective tissue and vasculature of the nose predisposes aging individuals to chronic rhinitis making the percentage of the elderly with nasal symptoms significantly higher than the general population.
The elderly have generalized decrease in body water content and, along with a degeneration of mucous-secreting glands; the effectiveness of the mucociliary system is reduced, resulting in symptoms of nasal stuffiness. In addition, a decrease in nasal blood flow leads to atrophy and drying of the nasal mucous membrane and increased mucous viscosity. Structural changes in the nose with age include atrophy of the collagen fibers and loss of elastic fibers in the dermis. Weakening of the upper and lower nasal cartilage, retraction of the nasal columella, and downward rotation of the nasal tip contribute to an increase in nasal airway resistance.
This article will deal with the special considerations of treating rhinitis in the older population. Appendix 1 lists the specific factors that may affect general medical treatment in the elderly. The elderly patient is frequently being treated for a variety of medical conditions with a number of medications. The more medications that are prescribed the less likely the patient is to comply. Aside from complying with directions for a large number of medications, the elderly patient frequently has cognitive dysfunction with a resultant decrease in memory.
A number of changes in body composition associated with growing older may effect distribution of particular medications. These changes include decrease in muscle mass, fat and body water. Medications metabolized through the liver and kidney may be affected by decrease in function of the organ systems. Finally, many elderly patients have limited financial resources and may simply not be able to afford the cost of the prescribed medications.
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Rhinitis in the elderly is a common but often neglected condition. Structural changes in the nose associated with aging, predisposes the elderly to rhinitis. There are a number of specific factors that affect medical treatment of the elderly including polypharmacy, cognitive dysfunction, changes in body composition, impairment of liver and renal function and the cost of medications in the face of limited resources. Rhinitis in the elderly can be placed in several categories and treatment should be appropriate for each condition. The most important aim is to moisten the nasal mucosa since the nose of the elderly is so dry. Great caution should be used in treatment with first generation antihistamines and decongestants. Medications generally well tolerated by the elderly are second generation antihistamines, intra-nasal anti-inflammatory agents, leukotriene modifiers and iprapropium nasal spray.
Rhinitis is a common and bothersome condition in the elderly. Despite its importance, little attention is paid in the general medical literature. In the most recently published highly regarded geriatric text, rhinitis is not included in the index whereas rhinophyma is. The number of Americans older than 65 years of age will increase from 35 million to 86 million by the year 2050. While the exact number of elderly patient with rhinitis is not known, it is believed that 40% of the general population experiences nasal symptoms. It would be safe to say that the many changes that occur in the connective tissue and vasculature of the nose predisposes aging individuals to chronic rhinitis making the percentage of the elderly with nasal symptoms significantly higher than the general population.
The elderly have generalized decrease in body water content and, along with a degeneration of mucous-secreting glands; the effectiveness of the mucociliary system is reduced, resulting in symptoms of nasal stuffiness. In addition, a decrease in nasal blood flow leads to atrophy and drying of the nasal mucous membrane and increased mucous viscosity. Structural changes in the nose with age include atrophy of the collagen fibers and loss of elastic fibers in the dermis. Weakening of the upper and lower nasal cartilage, retraction of the nasal columella, and downward rotation of the nasal tip contribute to an increase in nasal airway resistance.
This article will deal with the special considerations of treating rhinitis in the older population. Appendix 1 lists the specific factors that may affect general medical treatment in the elderly. The elderly patient is frequently being treated for a variety of medical conditions with a number of medications. The more medications that are prescribed the less likely the patient is to comply. Aside from complying with directions for a large number of medications, the elderly patient frequently has cognitive dysfunction with a resultant decrease in memory.
A number of changes in body composition associated with growing older may effect distribution of particular medications. These changes include decrease in muscle mass, fat and body water. Medications metabolized through the liver and kidney may be affected by decrease in function of the organ systems. Finally, many elderly patients have limited financial resources and may simply not be able to afford the cost of the prescribed medications.
DOWNLOAD COMPLETE PDF HERE
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