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Pulmonary embolism in the elderly.

A R Berman1

  • 1Division of Pulmonary Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.

Clinics in Geriatric Medicine
|March 29, 2001
PubMed
Summary
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Pulmonary embolism (PE) is underdiagnosed and undertreated in the elderly. Increased awareness and prompt management, including anticoagulation and considering thrombolysis, can reduce PE-related mortality and morbidity in older adults.

Area of Science:

  • Gerontology
  • Cardiology
  • Pulmonology

Background:

  • Elderly individuals face heightened risks for pulmonary embolism (PE) due to age-related conditions and immobility.
  • The incidence and mortality rates of PE significantly increase with age.
  • Diagnosing PE in the elderly is challenging due to nonspecific symptoms often attributed to other conditions.

Purpose of the Study:

  • To review the diagnostic challenges and management strategies for pulmonary embolism in the elderly population.
  • To emphasize the importance of early diagnosis and appropriate treatment to reduce morbidity and mortality.

Main Methods:

  • Review of current diagnostic modalities for PE, including lower extremity studies, D-dimer, lung scanning, spiral CT, and pulmonary angiography.
  • Discussion of prophylactic measures and therapeutic interventions for PE in older adults.

Related Experiment Videos

  • Evaluation of treatment options such as anticoagulation, thrombolysis, and vena cava filters.

    • Main Results:

    • Diagnostic tests like D-dimer can be unreliable in the elderly due to comorbid conditions.
    • Spiral CT is as sensitive and specific as lung scanning for PE diagnosis.
    • Pulmonary angiography remains a valuable tool when initial studies are inconclusive and clinical suspicion is high.

    Conclusions:

    • Pulmonary embolism is frequently underdiagnosed and undertreated in the elderly population.
    • Prophylaxis and timely anticoagulation are crucial for managing PE in elderly patients.
    • Thrombolysis and vena cava filters have specific roles in managing hemodynamically unstable patients or those with contraindications to anticoagulation.