Congestive heart failure in older adults

Ageing, reduced mobility, lung disease and several medicines can produce symptoms that overlap with heart failure. A person may notice less stamina, needing more pillows, waking at night short of breath, or swelling around the ankles. Some older people show reduced appetite, sleepiness or new confusion rather than describing breathing trouble. Heart failure can also coexist with hypertension or atrial fibrillation, so the overall pattern matters.

A clinician will consider previous heart problems, kidney function, blood pressure, medicines and changes from the person’s usual routine. A new symptom is not automatically heart failure, and heart failure should not be dismissed as normal ageing.

Keep a current list of medicines, including non-prescription pain medicines, and record changes in swelling, breathing, sleep and walking ability. Take medicines exactly as prescribed; some treatments require monitoring of kidney function, blood pressure or electrolytes. A clinician may recommend an echocardiogram, electrocardiogram, blood tests or a chest assessment.

Help the person attend follow-up visits, use prescribed mobility support and follow individual advice about fluids, salt and activity. A Chronic Disease Review can bring symptoms, medicines and practical support together.

Call emergency services for severe breathing difficulty, chest pain, fainting, blue lips, sudden confusion or inability to stay awake. Seek same-day medical advice if swelling increases quickly, breathing becomes harder when resting, a new cough develops at night, or the person is markedly less alert or mobile. Bring the medicine list and note when the change began.

Which changes are expected, and which need a same-day call? Could any medicine be worsening swelling or dizziness? How will kidney function and blood pressure be checked? What level of walking is appropriate? Who should be contacted outside clinic hours?