Considerations for Aging Patients
People older than 65 represent the fastest-growing segment of the population.
More than 20 percent of U.S. residents will be 65 or older in 2030. Of all
Americans 65 and older, 14.1 percent report that they suffer from chronic
sinusitis; for those 75 years and older, the rate declines to 13.5 percent. The
prevalence of this condition among the elderly ranks behind arthritis,
hypertension, hearing impairments, heart disease, cataracts, and orthopedic
impairments. However, more Americans report having sinusitis than diabetes.
Geriatric Rhinitis Complaints are:
- constant need to clear the throat
- a sense of nasal obstruction
- nasal crusting
- vague facial pressure
- decreased sense of smell and taste
For the most part, sinusitis symptoms, diagnosis, and treatment are the same
for the elderly as other adult age groups. However, there are special
considerations in older Americans:
Changing physiology: With aging, the physiology and function of the
nose changes. The nose lengthens, and the nasal tip begins to droop due to
weakening of the supporting cartilage. This in turn causes a restriction of
nasal airflow, particularly at the nasal valve region (where the upper and lower
lateral cartilages meet). Narrowing in this area results in the complaint of
nasal obstruction, often referred to as geriatric rhinitis.
Patients with geriatric rhinitis typically complain of constant "sinus
drainage," a chronic need to clear the throat or "hawk" mucus, and a sense of
nasal obstruction, most often when they lie down. Other features include nasal
crusting especially in the winter and in patients taking diuretics, vague facial
pressure (attributed to "sinus trouble"), and a decreased sense of smell and
However, it is a mistake to blame all upper respiratory problems on the aging
process. Elderly patients with symptoms such as repeated sneezing, and watery
eyes, nasal obstruction with clear profuse watery runny nose, and soft, pale
turbinates (top-shaped bones in the nose) may have allergic rhinitis. Patients
with this diagnosis will benefit from consultation with an otolaryngic
Patients with chronic sinusitis will have a long history of thick drainage
that is often foul smelling and tasting and is associated with nasal
obstruction, headaches, and facial pressure. These patients usually have pus
drainage and nasal redness. In contrast, the geriatric rhinitis patient usually
has a dry, irritated nose. The diagnosis of chronic sinusitis can be confirmed
with a screening coronal CT of the sinuses.
Recent studies by otolaryngologist-head and neck surgeons have sought to
better define the association between rhinitis and sinusitis. They have
concluded that sinusitis is often preceded by rhinitis and rarely occurs without
concurrent rhinitis. The symptoms, nasal obstruction/discharge and loss of smell
occur in both disorders. Most importantly, computed tomography (CT scan)
findings have established that the mucosal linings of the nose and sinuses are
simultaneously involved in the common cold (previously, thought to affect only
the nasal passages). Otolaryngologists, acknowledging the inter-relationship
between the nasal and sinus passages, now refer to sinusitis as
The fluids within these cavities are dynamic and are related to dynamic
pathologic changes in the bone and soft tissues of the nasal cavity and
paranasal sinuses. Symptoms associated with rhinosinusitis include nasal
obstruction, nasal congestion, nasal discharge, nasal purulence, postnasal drip,
facial pressure and pain, alteration in the sense of smell, cough, fever,
halitosis, fatigue, dental pain, pharyngitis, otologic symptoms (e.g., ear
fullness and clicking), and headache.
Osteoporosis: Osteoporosis is a significant health problem in the
United States affecting approximately 24 million Americans, 15 to 20 million of
whom are women over 45 years of age. Because of the concerns regarding prolonged
estrogen use in postmenopausal women, a nasal calcitonin spray is often
prescribed to prevent bone loss in perimenopausal women who cannot tolerate
estrogen. The most common side effect reported with nasal calcitonin spray is a
runny nose. Other symptoms that may occur include nasal crust, dryness, redness,
irritation, sinusitis, nose bleeds, and headache. Sinusitis sufferers using a
nasal calcitonin spray should advise their physicians.
Medications: Treatment for this age group needs to be more
individualized to meet the patient's slower metabolism and the increasing
potential for side effects. The majority (80 to 85 percent) of the nation's
elderly have chronic diseases and take multiple drugs including over-the-counter
medications, and risk drug interactions more often than other patients.
Surgery: Nasal and sinus surgery is occasionally advised for older
patients. Patients with structural abnormalities, such as a deviated septum or
nasal valve collapse causing severe nasal problems, should be referred to an
otolaryngologist for evaluation and possible surgical management. Patients with
documented chronic sinusitis unresponsive to medications also should be referred
to an otolaryngologist.
Sources: Administration on Aging (AoA), U.S. Department of Health and
Human Services; Geriatrics.
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© 2004 AAO-HNS/AAO-HNSF
Please read our disclaimer. Any information provided on this Web site should not be considered medical advice or a substitute for a consultation with Dr. Hector N. Hernandez or other healthcare professional. If you have a medical problem, contact us for diagnosis and treatment.