Department of Public Health and Primary Care, Katholieke Universiteit Leuven (KU Leuven), Leuven, Belgium.
Institute of Health and Society, Université Catholique de Louvain (UC Louvain), Leuven, Belgium.
J Am Geriatr Soc. 2023 Jul;71(7):2082-2095. doi: 10.1111/jgs.18326. Epub 2023 Mar 16.
Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio-respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi-system age-related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system-based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi-factorial mechanisms of breathlessness in community-dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi-modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence-based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults.
呼吸困难在老年人中很常见，但通常被视为“正常衰老”或被狭隘地认为是心肺疾病的症状。关于老年人呼吸困难的研究大多集中在特定疾病上，而老年人的特点是多种疾病和多系统与年龄相关的损伤。本文旨在概述目前已知的关于普通老年人群体呼吸困难的情况，并确定进一步研究的领域。研究表明，老年人的呼吸困难是一种多因素的老年病，跨越了基于系统损伤和疾病的界限，是不良预后的一个有价值的独立预后指标。进一步的研究需要调查（1）社区居住的老年人呼吸困难的多因素机制，包括呼吸肌减少症的作用；（2）老年时情感和认知变化对呼吸困难的感知和报告的影响；（3）在一般老年评估中评估和使用呼吸困难来预测不良预后的最佳方法；以及（4）最合适的多模式康复干预措施及其结果。临床医生需要将呼吸困难的处理方法从一种疾病症状转变为一种多因素的老年病，这种病应该主动寻找，因为它可以识别出更高的不良预后风险，并且可以通过循证干预措施来解决，这些干预措施可以提高生活质量，并可能降低老年人的不良预后风险。
