Diagnosis and Treatment
The diagnosis of heart failure in the elderly is based on the history,
physical examination, chest radiograph, and ECG findings.
However, the presenting symptoms of heart failure often
are difficult to evaluate.
Treatment of heart failure in the elderly involves many of
the same methods as in younger persons. Activities are restricted
to a level that is commensurate with the cardiac reserve.
Seldom is bed rest recommended or advised. Bed rest causes
rapid deconditioning of skeletal muscles and increases the risk
of complications, such as orthostatic hypotension and thromboemboli.
Instead, carefully prescribed exercise programs can
help to maintain activity tolerance. Even walking around a
room usually is preferable to continuous bed rest. Sodium restriction
usually is indicated.
Age- and disease-related changes increase the likelihood of
adverse drug reactions and drug interactions. Drug dosages and
the number of drugs that are prescribed should be kept to a
minimum. Compliance with drug regimens often is difficult;
the simpler the regimen, the more likely it is that the older
person will comply. In general, the treatment plan for elderly
persons with heart failure must be put in the context of the person’s
overall needs. An improvement in the quality of life may
take precedence over increasing the length of survival.