Geriatric dyspnea: Doing worse, feeling better

• Physical fitness and efficiency of the respiratory system decline in older age.
• Paradoxically, dyspnea report is reduced in older compared to younger individuals.
• Age-related reduction in dyspnea report is a serious barrier for diagnostics and treatment.
• We outline physiological, psychological, and social pathways in dyspnea in older age.
• The model identifies individuals at risk and pathways for intervention.

Older age is associated with a decline in physical fitness and reduced efficiency of the respiratory system. Paradoxically, it is also related to reduced report of dyspnea, that is, the experience of difficult and uncomfortable breathing. Reduced symptom reporting contributes to misdiagnosis or late diagnosis of underlying disease, suboptimal treatment, faster disease progression, shorter life expectancy, lower quality of life for patients, and considerably increased costs for the health care system in an aging society. However, pathways in the complex relationship between dyspnea and age are not well explored yet.We propose a model on geriatric dyspnea that integrates physiological, neurological, psychological and social pathways which link older age with dyspnea perception and expression. We suggest that the seemingly paradox of reduction of dyspnea in older age, despite physiological decline, can be solved by taking age-related changes on these multiple levels into account. In identifying these variables, the Geriatric Dyspnea Model highlights risk factors for reduced dyspnea perception and report in older age and pathways for intervention.