February 16, 2023 – A 70-year-old patient walks into the physician’s office complaining of stomach pain. There’s a chance they have hearing loss, making communication difficult. They might have comorbidities and are taking multiple prescription medications, each with its own side effects and drug interactions, making it difficult to isolate the problem at hand. They could have memory loss and find it difficult to recall when their symptoms began. Nor can the doctor get a good read on their circumstances outside the office, such as their housing situation, access to nutritious food, and social or family relationships.
Taking all these factors into consideration, the odds of misdiagnosis, underdiagnosis or overdiagnosis is high.
In July, the National Academies of Sciences hosted a workshop on “Advancing Diagnostic Excellence for Older Adults.” In the Proceedings, published in November, there’s little mention of diagnostic technologies. Rather, the emphasis was on the interaction between the care team and patient. According to one participant, the vulnerability of older adults due to isolation, challenges related to hearing, cognition and mobility, as well as complications from medications create challenges in caring for this population and highlight the need for whole-person care.
In a six-year-old study, researchers from Australia combed literature for data on the rates of misdiagnosis of common diseases in older populations. While admitting that literature was limited, they concluded that clinically significant rates of overdiagnosis and underdiagnosis exist for Parkinson’s disease, heart failure, acute myocardial infarction, dementia and chronic obstructive pulmonary disease.
They concluded that the presence of physical comorbidities was consistently associated with lower accuracy regarding the diagnoses of COPD, dementia, Parkinson’s, heart failure, stroke/TIA (transient ischemic attack) and acute myocardial infarction, possibly because complaints and fatigue due to concurrent diseases mask features that support or refute the index diagnosis.
Read more in the latest issue of Repertoire Magazine.