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Aging News & Opinion

Cheers for the ‘Age-Adjusted’ Cutoff Making Pulmonary Embolism Test Work for Senior Citizens

Is this a break-through in health care adjusting to meet the demands of an aging society that is different than the one we grew up in?

By Tucker Sutherland, editor, SeniorJournal.com

March 18, 2014 – Probably more common sense should be applied to the medical care of older people. A study released today by the prestigious Journal of the American Medical Association (JAMA) lauds the accomplishment of international doctors who solved the problem of a blood test for pulmonary embolism (blood clot in lungs) that was no longer working for senior citizens. Seniors seem to find themselves increasingly excluded from certain medical testing due to their advanced age.

In this particular case, measuring D-dimer - a breakdown product of a blood clot - levels is one way doctors exclude a diagnosis of pulmonary embolism (PE). The problem was that several studies had revealed that D-dimer levels increase with age. So, it was becoming increasingly difficult to use this blood test for older people to determine if they had suffered a blood clot in their lungs.

For most commercial tests and abnormal reading of above 500 µg/L for D-dimer was supposed to indicate a PE problem. But, with increasing numbers of old people in the world, the results were increasingly above the 500 level. The test was becoming less useful for seniors, as more and more healthy seniors were testing positive.

It took Marc Righini, M.D., of Geneva University Hospital, Geneva, Switzerland, and his colleagues to decide that maybe there needed to be an “age-adjusted” D-dimer threshold for a positive reading.

 

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Their solution to accommodate the increasing scores by older people was to multiply the patient’s age by ten in patients 50 years or older. So, if the patient was age 60, the test reading to determine if the patient scored abnormal of normal became 600, rather than 500.

They found it seemed to safely exclude the diagnosis of PE in elderly patients who had been suspected of PE.

The study was expanded to include 19 centers in Belgium, France, the Netherlands, and Switzerland between January 2010 and February 2013. To be assured of their results, the outpatients in the study underwent a clinical probability assessment (measured by one of two scoring systems based on risk factors and clinical findings), D-dimer measurement, and computed tomography pulmonary angiography (CTPA; image of lungs).

Of the 3,346 patients with suspected PE included in the analysis, the prevalence of PE was 19 percent. The researchers found that combining the probability assessment with adjustment of the D-dimer cutoff for the patient’s age safely excluded the diagnosis of PE and was associated with a low likelihood of subsequent PE or other venous blood clot.

As suspected, and logic would indicate, among elderly patients, there was an increase in the proportion of patients in whom PE could be excluded without further imaging.

“Future studies should assess the utility of the age-adjusted cutoff in clinical practice. Whether the age-adjusted cutoff can result in improved cost-effectiveness or quality of care remains to be demonstrated,” the authors conclude.

It doesn’t sound like the greatest challenge in medical science, but it has to be encouraging to senior citizens and their advocates that the medical world is taking the time to consider the differences in people as we age. Too often the scenario seems to be one where the health care establishment had rather just exclude senior citizens from test that made adjustments to meet the needs of a changing, aging society.

“Longer life spans and aging baby boomers will combine to double the population of Americans aged 65 years or older during the next 25 years to about 72 million. By 2030, older adults will account for roughly 20% of the U.S. population,” according to Aging & Health in America 2013, published by the Centers for Disease Control and Prevention.

The diseases that claimed our ancestors, like tuberculosis, diarrhea and syphilis, are no longer our biggest worries. They have been replaced, primarily by the two big killers, heart disease and cancer.

But, the risk of developing chronic diseases increases as a person ages, and with more older people, this problem grows. Two of three older Americans have multiple chronic conditions, and treatment for this population accounts for 66% of the country’s health care budget.

The nation’s health care system is largely designed to treat one disease or condition at a time, but many Americans have more than one, and often several, chronic conditions. For example, just 9.3% of adults with diabetes have only diabetes. Other common conditions include arthritis, asthma, chronic respiratory disease, heart disease, and high blood pressure.

“As more and more Americans reach the age of 65, society is increasingly challenged to help them grow older with dignity and comfort. Meeting these challenges is critical to ensuring that baby boomers can look forward to their later years,” says the CDC.

Hopefully, the term “age-adjusted cutoff” is one we will hear more often.
 

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