Adapted with permission from Dr. Brett Heilbron, Consultant Cardiologist, Copeman Healthcare Centre
Seniors are the fastest-growing age group in Canada. This trend is expected to continue for the next several decades due to a decreased fertility rate and increase in life expectancy. The life expectancy of Canadian men and women is expected to reach 81 and 86 years respectively by 2040. Currently, 14.4% of Canadians are 65 and older. By 2041, close to 1 in 4 Canadians are going to be 65 and over (9.2 million).
Heart and brain diseases are highly age-related, and share common risk factors. As the population ages, the prevalence of heart and brain disease is set to increase to epidemic proportions.
(Fitchett D, et al. Can J Cardiol 2004;20 Suppl A:7A-16A.)
Treatment goals in elderly patients may have different priorities compared to younger individuals. While prolonging survival may be the priority in younger people, improved quality of life clearly must be the first priority in the elderly, with enhanced survival also a goal whenever possible.
Traditionally, people over the age of 65 were referred to as the elderly. Given the changes in the demographics of our population, the definition of the term “elderly” may need some revision. Two useful ways to characterize the elderly are by chronological age and biological age on the basis of frailty and relative fitness. The elderly population is more likely to suffer from various cardiovascular risk factors, cardiac disease and brain disease yet cardiovascular risk factor modification is standard practice only with young and middle-aged adults.
One of the significant benefits of treating cardiovascular risk factors is preventing brain decline. In the Progress Trial, patients with previous ischemic stroke or transient ischemic attack were given perindopril to reduce their blood pressure. Results showed significantly reduced stroke-related dementia (34%) and severe cognitive decline (19%). The HYVET-COG study found that lowering blood pressure with perindopril decreased dementia 14% more than active treatment with a placebo.