Diagnosis and Management in the Elderly

Deirdre A. Jenkins, MD
Richard C. Woodman, MD
Division of Hematology and Hematological Malignancies,
University of Calgary and Tom Baker Cancer Centre, Calgary, AB.

Introduction
Chronic lymphocytic leukemia (CLL) is a monoclonal disorder of long-lived, mature lymphocytes. It is the most common leukemia in North America with an incidence of 2.7 cases per 100,000. CLL is primarily a disease of the elderly, with a median age of 70 at diagnosis and a slight male predominance. In patients older than 85 years, the incidence rises to 30.6 per 100,000.¹ There are no clear hereditary patterns; however, increased incidence is noted in families with other lymphoproliferative disorders. The etiology is unknown, and typical risk factors for other cancers (like viruses, radiation and chemicals) have no clear role in CLL. The importance of understanding the diagnosis and treatment of this disorder lies in the chronic nature of the disease, as patients may live years to decades after diagnosis. Knowing your treatment goals, and anticipating complications are fundamental for managing patients with CLL.

Diagnosis
While there has been a growing number of patients serendipitously diagnosed on routine blood tests, the majority of patients will present with symptoms referable to their disease (Table 1).

Lucia Gagliese, PhD
Assistant Professor, School of Kinesiology and Health Science, York University,
Staff Scientist, Department of Anaesthesia, University Health Network, and
Assistant Professor, Department of Anaesthesia, University of Toronto.

Brenda Kraetschmer, RN, BScN
Clinical Research Coordinator,
Department of Anaesthesia, Mount Sinai Hospital and
University Health Network, Toronto, ON.

As the population ages, health care workers will increasingly be called upon to provide effective pain assessment and management to elderly patients. Fortunately, information regarding age-related patterns of pain, disability and psychological distress has become more readily available over the past decade. However, this area of study remains in its infancy and further research is urgently needed. In this article, we present a brief overview of some of the most recent data about the epidemiology, assessment and management of chronic pain in elderly people.

Epidemiological Studies
There is no clear-cut pattern of age differences in the prevalence of pain. Results vary depending on the population and type of pain studied.¹ Epidemiological studies conducted in community settings have found that the prevalence of many pain complaints, including headache, migraine and low back pain, peaks in middle-age and decreases thereafter.