Description

The presentation of common diseases in older age is often referred to as atypical.

We undertook a literature review to determine how the following common diseases: acute coronary syndrome (ACS), pulmonary embolism (PE), pneumonia and congestive cardiac failure (CCF) present in older and younger adults.

We identified 40 papers describing 11,183 patients in total. Older patients with ACS are more likely to present without chest pain than younger patients, and are more likely to present with breathlessness than younger patients. Older patients with PE are more likely than younger patients to present with syncope and less likely to present with haemoptysis. Older patients with pneumonia are more likely to present with confusion than younger patients, and are less likely to present with a fever. There is insufficient evidence to draw conclusions about differences in the presentation of cardiac failure between young and older adults.

This review has confirmed that the presentation of ACS, PE and pneumonia may be different in older compared to younger people. Older people were more likely to present with non-specific symptoms, but the mechanisms underlying this are uncertain. Care should be taken not to miss unexpected but serious diseases in older people.