Age-related diseases demand attention

Washington -- Some lesser-known diseases that strike older adults could, in the near future, spring from the shadows of more familiar illnesses like cancer, heart disease and Alzheimer's disease to catch the unwary physician by surprise, warned clinicians and researchers speaking at a Sept. 21 congressional briefing.

They identified these conditions as:

• Chronic obstructive pulmonary disease, currently in fourth place among the leading causes of death in the United States and poised to move into third place as the population ages.
• Urinary incontinence, while not caused by aging, still manages to affect millions of older people who structure their lives around the availability of a bathroom.
• Age-related macular degeneration, the leading cause of blindness in the nation, which is stealing the independence of many elderly people by making it impossible for them to read, drive or write a check.

"We need to train physicians and other health care providers to recognize these diseases and not to dismiss them by saying, 'Sorry, you're 85 years old, what do you expect anyway?' " said Daniel Perry, executive director of the Alliance for Aging Research, which sponsored the briefing.

Focusing on the lungs

Even as the prevalence rates of many diseases that cause death and disability are declining, rates of COPD are increasing, said William Bailey, MD, director of the Lung Health Center at the University of Alabama, Birmingham.

At least 10 million to 15 million people in the United States have the disease, and there are probably twice as many people who are undiagnosed, he said. The disease is also referred to as emphysema and chronic bronchitis, depending on its path of destruction in the lungs. Most people with COPD have both forms.

Often the diagnosis is missed because its risk factors are also associated with heart disease and other disorders, said Dr. Bailey. "So a lot of people show up with a cough and shortness of breath and have a diagnosis of heart disease." The treatment focus is on heart disease, and the COPD is left untreated, he said.

Smoking causes about 90% of the disease in the United States and most of the rest of the developed world, although certain people also have a genetic predisposition. "But even if everyone quit smoking today, the disease would continue and not peak until 2020," said Dr. Bailey.

As people age, there is a normal decline in lung function. However, the decline is hastened by smoking or other environmental hazards including exposure to secondhand smoke, animal dander or dust mites.

"We recommend that smoking status be routinely included among the vital signs taken at patient visits," said Dr. Bailey. Physicians should ask whether a patient is a current smoker, had previously smoked or has never smoked.

At age 55 or 60, about 20% of current smokers will be diagnosed with COPD, and that percentage increases with age. Most current smokers begin to quit and the health community begins to pay attention to them when they get the disease, said Dr. Bailey. "But we need to move this whole operation back and get people to quit well before that."

COPD is not fully reversible, so when it starts, people continue to decline unless treatment is provided, said Dr. Bailey.

Early diagnosis means checking pulmonary function with spirometry for all those at risk. "It's simple, but not often done," he said. Treatment is based on the severity of the disease, beginning with occasional use of a bronchodilator; then more consistent use of bronchodilators accompanied by the use of anti-inflammatory agents and eventually oxygen therapy and surgery.

Worthy of attention

Another disease in the shadows is incontinence, said Neil M. Resnick, MD, director of the University of Pittsburgh's Institute on Aging. "You wake up in the morning to see if you've soaked the bed, you make sure your schedule has plenty of breaks, you don't dare sit on your daughter's new couch, or pick up your grandchild," he said. "This is what incontinence is for 20 million people."

There are also medical implications, he noted. Fractures result from falls occurring while running to the bathroom, and bladder infections and skin breakdowns are much more common in people with incontinence. And the condition's psychosocial implications include loss of self-esteem and depression, said Dr. Resnick.

The good news is there are several treatments that include lifestyle changes, exercises, medicines and surgery, but the bad news is the treatments aren't great and only about a third of those treated are cured or controlled, he said.

The disorder is rarely studied, and research funding is scant, said Dr. Resnick. "We don't know the causes or what protects some people from developing incontinence."

Additionally, experts expect to see age-related macular degeneration much more frequently in an older population, said Frederick L. Ferris III, MD, director of the National Eye Institute's Division of Epidemiology and Clinical Research. More than 1 million people have advanced AMD, and another 8 million are at high risk for related central vision loss.

Current treatments include laser photocoagulation that destroys the abnormal blood vessels that cause the vision loss, and photodynamic therapy that also closes abnormal blood vessels but poses less risk to normal blood vessels than does the laser treatment.

But the best approach is prevention, he said. A study two years ago did produce some promising results when high-dose combinations of vitamins C and E, betacarotene and zinc were found to lower the risk by 25% of those most likely to develop advanced AMD and reduce the risk of vision loss by 19%. New trials are planned to examine the effectiveness of supplements of fish oil and another antioxidant, lutein, said Dr. Ferris.

Faced with an aging population, "The cost of not doing research still far outweighs the money we are putting into it," he said.