The ageing patient with haemophilia

Abstract

Older patients with haemophilia (PWH) face many challenges related not only to haemophilia but also to general comorbidities associated with ageing. This article discusses the clinical experience published about the high prevalence of diseases in older PWH. These conditions are managed in the general population by healthcare workers with little training in haemophilia. Haemophilic arthropathy is common in elderly PWH. Prophylaxis starting at an early age in sufficient dose regimens to prevent arthropathy did not occur in patients who are now older than around 40 yr. Many PWH above this age thus have limitations in their activities of daily life. Cardiovascular diseases have become increasingly common in the growing, ageing cohort of PWH. Lifestyle issues such as sexual dysfunction may be exacerbated by the medical issues and psychological problems associated with haemophilia. Hepatitis C virus is a leading problem in PWH. Coinfection with HIV accelerates the progression to end-stage liver disease. Acute and chronic renal failure is more common in adult PWH than in general population. Other comorbidities are reviewed. The evidence is scarce, so it is imperative to report any experience regarding the diagnosis and treatment of these entities, to improve the quality of life of older PWH.

Life experience of the adult and ageing patient with haemophilia. Practical aspects for psychological support

“…At present, the quality of life of patients with haemophilia is similar to that of the general population, and better than that of other chronic conditions. Nevertheless, adult PWHs continue to experience bleeding, develop arthropathies and suffer chronic pain, especially those who did not have access to replacement factor or a prophylaxis regimen in their early years . Additionally, some live with the consequences of viral infection, an issue which has a dramatic impact on life, clinical management and QoL, resulting in the need for psychological counselling in addition to medical care .…”

“…With the clinical advances in haemophilia treatment, ageing of PWHs is the new challenge for healthcare professionals. Life expectancy in PWHs exceeds 70 years at present , and an increasing number of patients reach older age and experience the typical problems of ageing, such as comorbidities , age‐related depression or altered family dynamics . Psychological aspects of ageing in haemophilia have been, to our knowledge, scarcely described so far.…”

“…As previously mentioned, adults with haemophilia have to deal with the consequences of years of suboptimal treatment ; this is especially true for those born before the 1960s . Arthropathy and viral infections may have particular impact in older age .…”

“…The combination with age‐related ailments results in greater comorbidity and increased clinical complexity, psychosocial impact and negative impact on QoL . This is a new scenario both for healthcare providers and patients . The former must be prepared to provide up‐to‐date information and support , and PWHs should receive information on ageing and its implications with haemophilia.…”

Self-reported activity of Swedish persons with haemophilia: Change over 2.5 years

“…In recent years the ageing comorbidities for the adult population of PWH have been highlighted, and rehabilitation and physical activity have been mentioned as important, and even necessary, due to arthropathy and pain (24,25). Pre-existing geriatric comorbidities, such as hip arthrosis, together with haemophilia arthropathy, might have influenced the results of this study, especially with regards to self-care and walking distance.…”