Acute Pneumothorax: A Comparison of Elderly with Younger Patients

Abstract

This report compares the presentations and outcome of pneumothorax in 11 patients aged over 65 with 15 patients aged 20-35 years. Information was retrospectively collected from the charts regarding modes of presentation and the course of the illness. A questionnaire was sent to the general practitioners of the older group asking about the long-term outcome relating to functional status. Older patients were more likely than younger to present primarily with dyspnoea. The classical symptom of acute onset of pleuritic chest pain was present in ten of the 15 younger patients but in only two of the older patients. There were also statistically significant associations of the elderly patients with the following: radiological evidence of pre-existing lung disease; absence of pleuritic chest pain on admission; atypical or absent pain; a major delay from symptom onset to presentation; the diagnosis being clinically missed prior to chest radiography; and prolonged hospitalization. Nine of the 11 elderly patients were eventually independent at home.

Pulmonary embolism: differences in presentation between older and younger patients

“…The Wnding that older patients with acute PE less often experienced chest pain than younger patients has been previously described [4,6] although post-hoc review of the PIOPED study [5] did not Wnd a signiWcant difference (Table 6). Older people may have reduced visceral pain sensation, as has been previously described in case series including pneumothorax [15], peptic ulcer disease [16,17] and myocardial infarction [18]. It is also interesting to note that in our study, older patients who had chest pain were less likely to complain of it as their primary symptom.…”

Nonlinear Inverted-U Shaped Relationship Between Aging and Epidermal Innervation in the Rat Plantar Hind Paw: A Laser Scanning Confocal Microscopy Study

“…The persistent pain problems including surgical procedures have been observed to present with unusually painless manifestations in elderly population. Approximately 40% of patients over 65 years report little or no pain associated with peritonitis, intestinal obstruction, pneumothorax 36 , and peptic ulcer disease 19 . Several studies have suggested that elderly adults report less postoperative pain than younger patients experiencing the same surgical procedures 5, 46 .…”

Genetic diversity contributes to abnormalities in pain behaviors between young and old rats

“…These data indicate that visceral afferents of aged rats are less vulnerable to the effects of acetic acid sensitization which suggests that F344 rats have decreased sensitivity to a visceral insult with age. Our data have a high degree of clinical relevance given that the physiological role of pain is to alert the central nervous system to insults which may result in tissue damage, and a decreased awareness of visceral injury with age have severe health-related consequences resulting from a delayed diagnosis of specific disease states (Robinson and Gebhart 2008;Moore and Clinch 2004;Tresch 1998;Liston et al 1994;Hilton et al 2001). Indeed, our results are consistent with clinical literature where geriatric patients with organic disorders such as peptic ulcer disease may not present with abdominal pain until the occurrence of severe gastric damage, resulting in a poor prognosis and increased mortality from diseases-related complications (Vreeburg et al 1997).…”