25
Table 10. Geriatric Syndromes and Considerations in the
Management of PAD in Older Patients
Consideration Characterization
Mobility
impairment
• The presence of PAD was associated with poor physical function
compared with those without PAD.
• Ambulatory patients >75 y of age with PAD were 13.51-fold more
likely to experience functionally limiting pain than those without
PAD.
• Patients >65 y of age with PAD had a more rapid decline in life-
space mobility and a higher mortality rate than those without PAD.
Revascularization
considerations
• Age >80 y was associated with an increased mortality rate after
endovascular or surgical revascularization for infrainguinal PAD.
• Among patients ≥70 y of age with CLTI, those with dependent
functional status had a higher mortality rate than those with
independent functional status after infrainguinal bypass surgery.
• Older patients were less likely to be prescribed GDMT (including
antiplatelet therapy, statin, and ACE inhibitor/ARB) than those
10 y younger after endovascular revascularization.
• In patients >70 y of age with CLTI and <2-y predicted survival, a
comparison of treatment with medical therapy, endovascular, or
surgical revascularization showed no difference in QOL or health
status outcomes.
Impact of
amputation
• Morbidity and mortality rates associated with amputation in older
patients are exceptionally high, and mortality rates increased by
approximately 4% for every year of age.
• In older patients with CLTI at high risk for surgery, infrainguinal
bypass conferred lower risk of a 30-d mortality rate than
amputation.
• In patients >70 y of age treated for CLTI, 46 of 200 patients
underwent amputation within 1 y (23%), with significant
improvement in QOL at 6 and 12 mo but no difference in
objective measures of health status.
Polypharmacy • Typically described as prescribing ≥5 medications.
• Increasingly common in older patients (24% of older patients in
2000, and 39% of older adults in 2012).
• Tailoring of medical therapies and shared decision-making are
strategies to minimize impact of polypharmacy in older patients
with PAD.
(cont'd)
