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ALTERED DISEASE PRESENTATION

ANSWER TO CASE PRESENTATION QUESTION

Q: Can you think of some other types of altered disease presentations that occur in older people?

A: Other nonspecific presentations of illness include:

1) Muted or delayed "typical" symptoms
2) Presentation in a different organ system

reflects decreased/absent reserve in organ system with symptoms

for example, a person with a degree of cognitive impairment at baseline may manifest increasing confusion as the initial presentation of acute illness or a worsening of a chronic illness

the underlying problem could be a pneumonia, acute myocardial infarction, uncontrolled diabetes, etc.; it may require some detective work to determine the cause!

3) "Classic" altered presentations

examples: hyperosmolar non-ketotic state in an older diabetic patient, rarely seen in people under age 50; or apathetic thyrotoxicosis (depressed affect, non-activated appearance, in contrast to the hyperkinesis more typical of hyperthyroidism in younger patients)

4) Loss of function

"Mom is no longer able to do her gardening"

may herald onset of an acute illness or a worsening in a chronic illness

5) No symptoms

example: "silent" myocardial infarction in a diabetic patient, presenting with Q waves on a routine ECG. In fact, some of these patients probably did have symptoms that were non-specific ("I had the flu"), but the cause was unrecognized at the time.

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