Geriatric Rhinitis: Under-diagnosed and Undertreated
To make matters more complicated, not all rhinitis in the older adult has an allergic basis. Nasal problems are a common complaint in the older adult. These problems are often presented to the physician as "sinus trouble" with thick postnasal drainage associated with frequent throat clearing and nasal congestion. While these symptoms are nonspecific, and similar to other types of rhinitis, the use of decongestants and antihistamines may make the symptoms of geriatric rhinitis worse.
The etiology of geriatric rhinitis is best explained by examining the physiology of the aging nose. With aging, there is nasal airway narrowing secondary to weakening of the supporting cartilage. This may render symptomatic any minor deviations in the septal cartilage that were previously asymptomatic and give rise to a complaint of nasal obstruction. In addition, nasal glandular atrophy reduces the number of submucosal glands; this leads to thicker mucus, which presents as the need for repeated throat-clearing, coughing, or persistent foreign body sensation in the throat. Aging also gives rise to a decrease in microvascular blood flow, leading to dryness and crusting. In addition, medications commonly used in older adults such as diuretics, beta-blockers, anxiolytics, and antivertigo drugs also contribute to nasal dryness and congestion.
The differential diagnosis of rhinitis in older adults includes allergic rhinitis, chronic sinusitis, and vasomotor rhinitis, in addition to the age-related changes leading to geriatric rhinitis. As a result, certain cases may benefit from allergy testing and/or a CT scan of the sinuses. If allergy testing is carried out, due to changes in aging skin, prick-puncture skin testing is advocated as the best method for allergy testing in the older adult.
Once the diagnosis of geriatric rhinitis is made, the treatment is to increase moisture inside the nose. This may be accomplished by increasing mucus production with a maximum dose of guaifenesin 2,400 mg/day, increasing moisture by the topical application of saline via nasal spray four to six times daily, and/or the use of home humidifiers. First-generation antihistamines such as chlorpheniramine should be avoided because they can dry nasal membranes. Therefore, if allergic rhinitis is suspected in the older adult, second- or third-generation antihistamines such as loratidine should be considered. Nasal corticosteroids should used cautiously in the older person as they can worsen drying and crusting.[6,8] Cromolyn sodium nasal solution may be more effective in treating older adults with documented allergic rhinitis.
Geriatrics and Aging. 2005;8(5):52-53. © 2005 1453987 Ontario, Ltd.
Views and opinions in this publication are not necessarily endorsed by, or reflective of the views and opinions of the Regional Geriatric Programs of Ontario.
Cite this: Allergies in the Aging - Medscape - May 01, 2005.