General management of nonagenarian patients: a review of the literature

Abstract

The number of nonagenarian people in the world is steadily growing. This phenomenon will increase in future years: in 2050, world population prospects estimate 71.16 million people aged 90 years or older. The two main causes of death among people aged 85 years or more in Europe in 2003 were cardiovascular and cerebrovascular diseases and cancers. However, the elderly are often excluded from clinical trials; they are underrepresented in clinical registries and especially nonagenarians. Care (medical, surgical, oncology) of these very elderly is currently insufficiently based on scientific recommendations. For the physician, the choice to treat or not to treat very elderly patients (for fear of side effects) is difficult. Oncology is particularly affected by this problem. Here we review these different fields of internal medicine management of nonagenarian patients with a special focus on oncology and on comprehensive geriatric assessment as a base for all care decision taking.

Survival Prognosis in Very Old Adults

“…The life expectancy for an 80‐year‐old ranges from 8 to 10 years in high‐income countries but is still fairly short for 90‐year‐olds, ranging from 4 to 5 years. Comprehensive geriatric assessment instruments aim to identify current health problems and assist in medical decision‐making, but they are generally time‐consuming. Simpler screening tools exist, but the have mostly been validated in people aged 70 to 80 …”

“…With this growing number of oldest old adults, ageism has been decreasing in recent decades, and it has now become generally unacceptable to deny medical procedures to people aged 80 and older using advanced age as the sole argument . Research has also emerged that investigates medical procedures for very old adults, but life expectancy for very old adults is still short in most high‐income countries, ranging from around 8 to 10 years for 80‐year‐olds to 4 to 5 years for 90‐year‐olds (online Table S1) . Hence, overtreatment of very old adults is still a general concern, and potential side effects of treatment have to be balanced with the overall survival prognosis, which is generally based on the overall chance of survival to a given age or overall life expectancy .…”

Global Burden of Mental, Neurological, and Substance Use Disorders: An Analysis from the Global Burden of Disease Study 2010

“…Although the peak burden of mental, neurological, and substance use disorders is found in young adults, there is, unlike many chronic diseases, a significant burden in children and younger adolescents. For countries such as those in Sub-Saharan Africa where children constitute 40% of the population [35], these findings highlight the need for prevention and treatment services targeted to children and adolescents. The availability of such services is often more sporadic than for adult services.…”

Resilience to cognitive impairment in the oldest-old: design of the EMIF-AD 90+ study

“…The oldest-old (subjects aged 90 years and older) population represents the fastest growing segment of society [ 1 ]. Worldwide, the number of oldest-old subjects is expected to increase to 71.2 million in 2050, a 5-fold increase of the current oldest-old population [ 2 , 3 ]. The oldest-old have a high risk of developing dementia with a prevalence up to 40% [ 4 ].…”