Correspondence Address:
Dr. Arvind Mathur
Ex.Principal and Controller, Professor of Medicine, Dr S. N. Medical College, Rajasthan
India

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Prevalence of cardiovascular diseases, including Acute Coronary Syndrome (ACS), increases with age. Though older people have a high prevalence of the coronary disease, they are excluded from research studies assessing the efficacy and safety of therapies in these patients. Many elderly ACS patients do not receive evidence-based treatments; since the evidence to inform optimal care delivery to elderly patients with ACS is limited. Khan UH et al. have studied the clinical and coronary angiographic (CAG) profile of older adult patients with the acute coronary syndrome (ACS), assessed complications of percutaneous coronary intervention (PCI) and the 30-day mortality.[1] They have endorsed that older patients with ACS differ from their younger counterparts in their clinical presentation, co-morbidities, and outcome but tolerated CAG and PCI (if indicated) well. The optimized approach requires careful considerations of the individual patient's ischemic risk, co-morbidities, risk of complications, frailty, cognitive function, life expectancy and advanced directive (patient's wish). High-risk elderly ACS patients may benefit from aggressive antithrombotic therapy and invasive revascularization but may have higher risks of complications, such as bleeding and stroke. Advanced age should not preclude immediate angiography and reperfusion in STEMI patients.

Both physiologic and psychosocial changes affect the nutritional status of older adults. Cross-sectional studies in Asia show that low body weight and undernutrition are common in older adults, particularly in hospitalized or institutionalized patients. A survey by Uddin MT et al. from Bangladesh has also revealed a higher prevalence of malnutrition and risk of malnutrition in older people.[2] They also demonstrated that the nutrition status of elderly is significantly varied with their occupation, place of residence, marital status, religion, age, family type, living arrangement, take care, and sleeping disorder.

In older individuals chronic activation of the inflammatory response, "inflammaging", is the pathophysiological basis for anabolic resistance, sarcopenia and frailty. Many age-associated chronic diseases also increase the levels of inflammatory markers in older persons. Nutritional status and nutrients can theoretically modulate this phenomenon like an anti-inflammatory effect on ageing of n-3 PUFA intake. Krishnaswamy B et al. assessed the levels of inflammatory cytokines; highly sensitive C-reactive protein (hsCRP) and interleukin (IL)-6 in healthy older persons to determine their association with the nutritional status.[3] The hsCRP and IL-6 levels did not show significant elevation and association with older adults' nutritional status in the study. However, the study was cross-sectional with small sample size and did not include other inflammatory markers like interleukin-1 (IL-1) and tumour necrosis factor α (TNF-α). There is a need for high-quality studies testing the causal relationship between inflammation, nutrition and ageing.

Due to multiple co-morbidities, multiple doctors and symptoms specific over the counter self-medication, polypharmacy increases with advancing age. Polypharmacy leads to adverse drug reactions and an increase in potentially inappropriate medicines (PIMs). There are sparse studies on the prevalence of polypharmacy in the elderly in India. Aggarwal V et al. have revealed an alarmingly high prevalence of polypharmacy in an organized medical facility.[4] The scenario in general practice would be worse. It is essential to comprehensively evaluate the patient and deprescribe unnecessary medicines to reduce PIMs, adverse drug reactions, and drug-drug interactions. Increasing awareness about polypharmacy among the medical practitioners by continuing medical education and including geriatric medicine in the undergraduate medical curriculum will help address it.

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