Heart disease is a serious health concern for the aged, who are more likely to acquire cardiovascular disorders as a result of age-related changes in the body, lifestyle factors, and underlying health issues requiring focused elderly cardiac care. As Singapore’s population ages, the demand for specialist treatment for elderly persons with cardiac diseases has increased more than ever. Treating cardiac disease in the elderly needs careful consideration of the special obstacles presented by age, such as frailty, various chronic illnesses, and an increased risk of complications. This article will look at the unique issues involved in elderly cardiac care, such as common heart diseases in older persons, complications that may emerge, treatment options, and care facilities available in Singapore to manage these conditions. We will also talk about how healthcare providers customize treatment regimens for senior people to improve results and quality of life.

The Prevalence of Heart Disease in Elderly Patients

People’s hearts and blood arteries change as they age, increasing their risk of cardiovascular disease. According to the Singapore Ministry of Health, cardiovascular illnesses are still the major cause of death among older persons, with the risk of heart disease increasing dramatically after the age of 60. Common cardiac diseases affecting the elderly include:

• Coronary Artery Disease (CAD): This may develop when plaque buildup narrows or blocks the coronary arteries, limiting blood flow to the heart muscle. This disorder can cause angina (chest pain), heart attacks, and heart failure.
• Heart Failure: A disorder in which the heart fails to pump blood properly, resulting in fluid buildup in the lungs and other areas of the body. This illness is very common in the elderly and is frequently associated with a history of heart attacks, hypertension, or diabetes.
• Atrial fibrillation (AFib): An irregular heartbeat that raises the risk of stroke, heart failure, and other consequences. It is more common in elderly people due to age-related alterations in the heart’s electrical circuit.
• Valvular Heart Disease: Valvular disorders, such as aortic stenosis and mitral valve regurgitation, are more common in the elderly because the heart valves calcify or weaken over time, making it difficult for the heart to function effectively.
• Hypertension (High Blood Pressure): Hypertension is exceedingly frequent in older persons and is a significant risk factor for stroke, heart attack, and heart failure. Managing blood pressure is an important aspect of geriatric cardiac care.

These illnesses necessitate specialist therapy and care, as senior persons frequently exhibit different physiological reactions to drugs, procedures, and lifestyle modifications than younger people.

Special Considerations in Treating Heart Disease in Elderly Patients

Treating heart disease in the elderly presents particular problems due to the complex interaction of age-related changes, various comorbidities, and greater vulnerability to consequences. Healthcare practitioners must consider a number of issues while designing treatment programs for older persons.

1. Age-Related Changes in the Cardiovascular System

As humans age, their hearts and blood arteries alter structurally and functionally. The heart’s walls may thicken, the valves stiffen, and the arteries become less elastic, making it difficult for the heart to pump blood adequately. These changes might complicate the management of cardiac disease in older people, necessitating changes to treatment regimens.

• Reduced Cardiac Output: As the heart becomes less effective, aged patients may experience decreased cardiac output, which can cause symptoms such as weariness, shortness of breath, and fluid retention. Treatment strategies must be modified to account for the heart’s decreased ability to withstand stress.
• Slower Metabolism of Medications: Due to changes in liver and renal function, elderly adults frequently metabolize pharmaceuticals more slowly. This may raise the likelihood of side effects or drug toxicity. Healthcare practitioners must closely monitor drug doses and interactions.

2. Multiple Chronic Conditions (Comorbidities)

Many senior individuals suffer from various chronic health issues, including diabetes, hypertension, kidney disease, and arthritis. These comorbidities can complicate heart disease treatment since drugs and therapies for one ailment may have an impact on the management of another.

• Polypharmacy: Occurs when older persons are administered many medications for various diseases. This raises the likelihood of drug interactions, adverse effects, and medication noncompliance. Managing polypharmacy is an important part of geriatric cardiac care.
• Tailored Treatment Plans: Healthcare practitioners must create personalized treatment plans that balance the needs of various chronic illnesses while reducing the risk of consequences. This may include changing medications, emphasizing certain treatments, and coordinating care across doctors.

3. Frailty and Physical Limitations

Frailty is a prevalent problem in older adults, characterized by a reduction in strength, mobility, and overall physical function. Frail individuals may have trouble tolerating severe treatments like surgery or certain drugs, and they are more likely to have problems.

• Non-Invasive Treatments: For frail elderly patients, non-invasive or minimally invasive procedures may be preferable to major surgery. For example, transcatheter aortic valve replacement (TAVR) is a less intrusive alternative to standard open-heart surgery for treating aortic stenosis in the elderly.
• Rehabilitation & Physical Therapy: Cardiac rehabilitation programs are critical for older patients recovering from cardiac surgery or other treatments. These programs aim to improve mobility, strength, and cardiovascular fitness in a supervised setting.

4. Cognitive Decline and Mental Health

Cognitive decline, including dementia and mild cognitive impairment, is more prevalent in older persons. These disorders can impair a patient’s ability to stick to treatment plans, take prescribed medications, and follow nutrition and exercise guidelines.

• Caregiver Support: Caregivers play an important role in monitoring the patient’s therapy and ensuring adherence to medical instructions in cases of cognitive decline. Healthcare practitioners must include caregivers in treatment plan conversations to ensure that they understand the patient’s needs.
• Mental Health Considerations: Depression and anxiety are widespread among older cardiac patients. Treating mental health disorders is an essential component of comprehensive geriatric cardiac care, since untreated depression can worsen cardiovascular outcomes.

5. Increased Risk of Surgical Complications

Older persons are more likely to experience difficulties after cardiac surgery or other invasive treatments. This is due to variables like frailty, compromised immune systems, and pre-existing health issues.

• Risk Assessment: Before proposing surgery, healthcare providers must undertake a thorough risk assessment to determine whether the patient will tolerate the procedure. In rare circumstances, other treatments may be tried to reduce risk.
• Post-operative Care: This is very crucial for elderly people. This involves checking for infections, ensuring correct wound healing, and offering rehabilitation to recover mobility and strength.

6. End-of-Life Care and Advanced Care Planning

Some elderly people with advanced heart disease may receive treatment aimed at increasing quality of life rather than curing the disease. End-of-life care and advanced care planning are critical components of geriatric cardiac care, assisting patients and families in making informed decisions about treatment options and goals of care.

• Palliative Care: This focuses on symptom management, pain relief, and comfort for patients with advanced cardiac disease. This strategy is especially helpful for individuals who no longer qualify for severe therapy.
• Advanced Care Directives: Advanced care planning enables older patients to express their preferences for end-of-life care, such as resuscitation, mechanical ventilation, and other life-sustaining interventions. These discussions should include the patient, their family, and the healthcare staff.

Care Facilities for Elderly Cardiac Care in Singapore

Singapore has a large number of healthcare facilities that specialize in geriatric cardiac care. These hospitals offer extensive services, ranging from diagnosis and treatment to rehabilitation and long-term care. Here are some of the primary institutions and care alternatives available:

1. National Heart Centre Singapore (NHCS)

The National Heart Centre Singapore (NHCS) is the country’s foremost heart health institution, providing specialist care to elderly individuals with cardiovascular diseases. NHCS offers advanced diagnostic services, heart operations, and minimally invasive procedures that are specific to the requirements of older persons. It also provides cardiac rehabilitation programs to aid older people in recovering from heart surgery and improving their overall cardiovascular health.

2. National University Heart Centre Singapore (NUHCS)

The National University Heart Centre Singapore (NUHCS) is another leading heart care institution in Singapore, specializing in comprehensive cardiac treatment for the elderly. NUHCS provides a variety of services, including diagnostics, interventional cardiology, and heart surgery. The institution also offers rehabilitation and patient education to help elderly individuals manage their heart issues.

3. Tan Tock Seng Hospital (TTSH)

Tan Tock Seng Hospital (TTSH) is well-known for its Geriatric Cardiology Unit, which caters to the specific needs of older patients with heart disease. The hospital has specialty clinics for elderly persons, where tailored care programs address numerous comorbidities, frailty, and cognitive decline. TTSH also provides cardiac rehabilitation and long-term follow-up services.

4. Private Hospitals and Clinics

Several private hospitals in Singapore, like Mount Elizabeth Hospital and Gleneagles Hospital, provide specialized cardiac care for elderly patients. These clinics offer innovative diagnostic tools, minimally invasive procedures, and individualized treatment strategies for cardiac diseases. Private cardiology clinics also provide elderly cardiac care, emphasizing specialized treatment and patient-centered care.

5. Cardiac Rehabilitation Programs

Many Singapore hospitals have cardiac rehabilitation programs to help elderly people recover from heart surgery, heart attacks, and other cardiovascular catastrophes. These programs provide supervised exercise sessions, nutritional guidance, and emotional support. They are vital for increasing cardiovascular fitness and avoiding future cardiac problems.

6. Nursing Homes and Long-Term Care Facilities

Nursing homes and long-term care facilities in Singapore offer medical support, rehabilitation, and everyday care to senior people suffering from severe heart disease or other health concerns. Some hospitals offer specialized programs for controlling heart disease and other illnesses in older persons.

FAQs About Elderly Cardiac Care

1. Why are elderly patients more susceptible to heart disease?

Elderly patients are more likely to develop heart disease due to age-related changes in the cardiovascular system, such as arterial rigidity, heart wall thickness, and decreased cardiac output. Other factors, including hypertension, diabetes, and lifestyle habits, also contribute to an increased risk of heart disease in older persons.

2. What are the most frequent heart problems among older patients?

Coronary artery disease (CAD), heart failure, atrial fibrillation (AFib), valvular heart disease, and hypertension are all common heart disorders in the elderly. These conditions necessitate careful management to avoid complications.

3. Is cardiac surgery safe for the elderly?

Heart surgery can be performed safely on senior people, although the risks grow with age and the presence of other medical disorders. Healthcare practitioners undertake comprehensive risk evaluations to evaluate whether surgery is the best option. For some patients, minimally invasive procedures like transcatheter aortic valve replacement (TAVR) may be a safer option.

4. How does cognitive decline effect the elderly’s cardiac care?

Cognitive decline can complicate elderly cardiac care since it impairs a patient’s ability to adhere to treatment plans, manage medications, and follow lifestyle advice. In such circumstances, caregivers and family members play a critical part in the patient’s care.

5. What are the benefits of cardiac rehabilitation for the elderly?

Cardiac rehabilitation assists older individuals in recovering from heart surgery, heart attacks, or other cardiovascular events by boosting cardiovascular fitness, strengthening, and lowering the risk of future heart issues. It also offers emotional support and education about heart-healthy habits.

6. How do older patients manage multiple drugs for heart disease?

Managing many drugs (polypharmacy) can be difficult for elderly people. It is critical to schedule regular check-ups with a healthcare professional who can examine prescriptions, adjust dosages, and detect any potential drug interactions. Using pill organizers and setting reminders can also help with adherence.

7. What role do caregivers have in providing cardiac care to the elderly?

Caregivers play an important role in elderly cardiac care by assisting patients with adhering to treatment programs, managing medications, attending medical appointments, and living a heart-healthy lifestyle. Caregivers also provide emotional support, which is critical for patients facing the hardships of heart disease.

Conclusion

Cardiac care for the elderly requires a specific approach that takes into account the unique obstacles provided by age, comorbidities, frailty, and cognitive decline. Treating cardiac disease in older individuals entails a comprehensive plan that combines medical treatment, rehabilitation, and lifestyle adjustments to promote overall health and quality of life. Singapore’s elderly patients have access to world-class healthcare services, such as specialist heart centers, cardiac rehabilitation programs, and long-term care facilities that provide tailored treatment for heart disease management. Healthcare practitioners can assist elderly patients live longer, healthier lives by addressing their specific requirements and involve caregivers in the process. If you’re noticing potential heart disease symptoms or want to ensure your heart stays healthy, acting now can make a meaningful impact. Reach out to the Harley Street Heart and Vascular Centre for a comprehensive cardiac evaluation. Call +65 6235 5300 to arrange an appointment with our expert cardiologists. Your heart deserves the highest level of care—because your well-being is our top focus! Written by: Dr Michael MacDonald MB ChB, BSc (Hons), MRCP (UK), MD (Research), FESC (Europe).  Dr MacDonald was trained in the UK and is a senior Consultant Cardiologist.