General principles on caring for older adults

The aging population presents a unique challenge for the US health care system, which has traditionally focused on disease-centric health care delivery. Cardiovascular diseases are highly prevalent in older adults and impose an enormous burden on the aging society in terms of mortality, morbidity, disability, and health care costs. Optimal management of cardiovascular disease in older adults warrants special consideration of age-related changes in multiple organ systems as well as prevalent geriatric syndromes, such as frailty, multimorbidity, and cognitive impairment. The likelihood of benefit from cardiovascular therapies can vary considerably due to the physiologic vulnerability and coexisting problems. However, existing clinical trials and clinical practice guidelines generated under the cardiovascular disease-centric paradigm fail to adequately represent the complexity of aging. This chapter will provide an overview of aging physiology and geriatric syndromes, and outline principles of patient-centered goal-directed care to help older patients achieve their desired health status.