Advertisement

Rhinitis of the Elderly

  • Alan P. Baptist
  • Sharmilee M. Nyenhuis
Chapter

Abstract

As the aging population in the USA grows, it will be increasingly important for healthcare providers to effectively diagnose and manage rhinitis. Nasal symptoms such as rhinorrhea, congestion, sneezing, nasal/ocular pruritus, and postnasal drainage affect up to one-third of older adults, and significantly impact their quality of life. Several underlying factors associated with aging (such as structural changes and immunosenescence) may contribute to the pathogenesis of rhinitis in older adults. Although treatment options for rhinitis exist, there are unique features that must be considered when caring for older adults with rhinitis. These include an increased prevalence of atrophic rhinitis, the use of complementary and alternative medications (high among older adults), comorbidities, limited income, memory loss, and increased side effects of medications (many of which can cause rhinitis symptoms).

Keywords

Rhinitis Allergic rhinitis Nonallergic rhinitis Atrophic rhinitis Elderly Older adults 

References

  1. 1.
    Slavin RG. Special considerations in treatment of allergic rhinitis in the elderly: role of intranasal corticosteroids. Allergy Asthma Proc. 2010;31(3):179–84.CrossRefGoogle Scholar
  2. 2.
    Bakos N, Schöll I, Szalai K, Kundi M, Untersmayr E, Jensen-Jarolim E. Risk assessment in elderly for sensitization to food and respiratory allergens. Immunol Lett. 2006;107(1):15–21.CrossRefGoogle Scholar
  3. 3.
    Pinto JM, Jeswani S. Rhinitis in the geriatric population. Allergy Asthma Clin Immunol. 2010;6(1):10.CrossRefGoogle Scholar
  4. 4.
    Bauchau V, Durham SR. Prevalence and rate of diagnosis of allergic rhinitis in Europe. Eur Respir J. 2004;24(5):758–64.CrossRefGoogle Scholar
  5. 5.
    Bachert C, van Cauwenberge P, Khaltaev N. Allergic rhinitis and its impact on asthma. In collaboration with the World Health Organization. Executive summary of the workshop report. 7–10 December 1999, Geneva, Switzerland. Allergy. 2002;57(9):841–55.CrossRefGoogle Scholar
  6. 6.
    Ozdoganoglu T, Songu M, Inancli HM. Quality of life in allergic rhinitis. Ther Adv Respir Dis. 2012;6(1):25–39.CrossRefGoogle Scholar
  7. 7.
    Bousquet PJ, Demoly P, Devillier P, Mesbah K, Bousquet J. Impact of allergic rhinitis symptoms on quality of life in primary care. Int Arch Allergy Immunol. 2013;160(4):393–400.CrossRefGoogle Scholar
  8. 8.
    Warm K, Backman H, Lindberg A, Lundbäck B, Rönmark E. Low incidence and high remission of allergic sensitization among adults. J Allergy Clin Immunol. 2012;129(1):136–42.CrossRefGoogle Scholar
  9. 9.
    Simola M, Holopainene E, Malmberg H. Changes in skin and nasal sensitivity to allergens and the course of rhinitis; a long-term follow-up study. Ann Allergy Asthma Immunol. 1999;82(2):152–6.CrossRefGoogle Scholar
  10. 10.
    Busse PJ, Lurslurchachai L, Sampson HA, Halm EA, Wisnivesky J. Perennial allergen-specific immunoglobulin E levels among inner-city elderly asthmatics. J Asthma. 2010;47(7):781–5.CrossRefGoogle Scholar
  11. 11.
    Alvares ML, Khan DA. Allergic rhinitis with negative skin tests. Curr Allergy Asthma Rep. 2011;11(2):107–14.CrossRefGoogle Scholar
  12. 12.
    Rondon C, Canto G, Blanca M. Local allergic rhinitis: a new entity, characterization and further studies. Curr Opin Allergy Clin Immunol. 2010;10(1):1–7.CrossRefGoogle Scholar
  13. 13.
    Klimek L, von Bernus L, Pfaar O. Local (exclusive) IgE production in the nasal mucosa. Evidence for local allergic rhinitis. HNO. 2013;61(3):217–23.CrossRefGoogle Scholar
  14. 14.
    Bozek A, Ignasiak B, Kasperska-Zajac A, Scierski W, Grzanka A, Jarzab J. Local allergic rhinitis in elderly patients. Ann Allergy Asthma Immunol. 2015;114(3):199–202.CrossRefGoogle Scholar
  15. 15.
    Dykewicz MS, Fineman S, Skoner DP, Nicklas R, Lee R, Blessing-Moore J, et al. Diagnosis and management of rhinitis: complete guidelines of the joint task force on practice parameters in allergy, asthma and immunology. Ann Allergy Asthma Immunol. 1998;81(5):478–518.CrossRefGoogle Scholar
  16. 16.
    Jessen M, Janzon L. Prevalence of non-allergic nasal complaints in an urban and a rural-population in Sweden. Allergy. 1989;44(8):582–7.CrossRefGoogle Scholar
  17. 17.
    Olsson P, Berglind N, Bellander T, Stjärne P. Prevalence of self-reported allergic and non-allergic rhinitis symptoms in Stockholm: relation to age, gender, olfactory sense and smoking. Acta Otolaryngol. 2003;123(1):75–80.CrossRefGoogle Scholar
  18. 18.
    Settipane GA, Klein DE. Non allergic rhinitis—demography of eosinophils in nasal smear, blood total eosinophil counts and IGE levels. N Engl Reg Allergy Proc. 1985;6(4):363–6.CrossRefGoogle Scholar
  19. 19.
    Brandt D, Bernstein JA. Questionnaire evaluation and risk factor identification for nonallergic vasomotor rhinitis. Ann Allergy Asthma Immunol. 2006;96(4):526–32.CrossRefGoogle Scholar
  20. 20.
    Settipane RA. Other causes of rhinitis: mixed rhinitis, rhinitis medicamentosa, hormonal rhinitis, rhinitis of the elderly, and gustatory rhinitis. Immunol Allergy Clin N Am. 2011;31(3):457–67.CrossRefGoogle Scholar
  21. 21.
    Moore EJ, Kern EB. Atrophic rhinitis: a review of 242 cases. Am J Rhinol. 2001;15(6):355–61.PubMedGoogle Scholar
  22. 22.
    Ferguson JL, McCaffrey TV, Kern EB, Martin WJ 2nd. Effect of Klebsiella ozaenae on ciliary activity in vitro: implications in the pathogenesis of atrophic rhinitis. Otolaryngol Head Neck Surg. 1990;102(3):207–11.CrossRefGoogle Scholar
  23. 23.
    Dykewicz MS, Fineman S, Joint Task SDP. Force Algorithm and Annotations for Diagnosis and Management of Rhinitis. Ann Allergy Asthma Immunol. 1998;81(5):474–7.CrossRefGoogle Scholar
  24. 24.
    McCue JD. Safety of antihistamines in the treatment of allergic rhinitis in elderly patients. Arch Fam Med. 1996;5(8):464–8.CrossRefGoogle Scholar
  25. 25.
    Holgate ST, Canonica GW, Simons FE, Taglialatela M, Tharp M, Timmerman H, et al. Consensus Group on New-Generation Antihistamines (CONGA): present status and recommendations. Clin Exp Allergy. 2003;33(9):1305–24.CrossRefGoogle Scholar
  26. 26.
    Golden SJ, Craig TJ. Efficacy and safety of azelastine nasal spray for the treatment of allergic rhinitis. J Am Osteopath Assoc. 1999;99(7 Suppl):S7–12.PubMedGoogle Scholar
  27. 27.
    Peter G, Romeis P, Borbe HO, Büker KM, Riethmüller-Winzen H. Tolerability and pharmacokinetics of single and multiple doses of azelastine hydrochloride in elderly volunteers. Arzneimittelforschung. 1995;45(5):576–81.PubMedGoogle Scholar
  28. 28.
    Grossman J, Gopalan G. Efficacy and safety of mometasone furoate nasal spray in elderly subjects with perennial allergic rhinitis. J Allergy Clin Immunol. 123(2):S271.CrossRefGoogle Scholar
  29. 29.
    Armentia A, Fernández A, Tapias JA, Méndez J, de la Fuente R, Sánchez-Palla P, Sanchís E. Immunotherapy with allergenic extracts in geriatric patients: evaluation of effectiveness and safety. Allergol Immunopathol (Madr). 1993;21(5):193–6.Google Scholar
  30. 30.
    Asero R. Efficacy of injection immunotherapy with ragweed and birch pollen in elderly patients. Int Arch Allergy Immunol. 2004;135(4):332–5.CrossRefGoogle Scholar
  31. 31.
    Marogna M, Bruno ME, Massolo A, Falagiani P. Sublingual immunotherapy for allergic respiratory disease in elderly patients: a retrospective study. Eur Ann Allergy Clin Immunol. 2008;40(1):22–9.PubMedGoogle Scholar
  32. 32.
    Bozek A, Ignasiak B, Filipowska B, Jarzab J. House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis. Clin Exp Allergy. 2013;43(2):242–8.CrossRefGoogle Scholar
  33. 33.
    Bozek A, Kolodziejczyk K, Warkocka-Szoltysek B, Jarzab J. Grass pollen sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with seasonal allergic rhinitis. Am J Rhinol Allergy. 2014;28(5):423–7.CrossRefGoogle Scholar
  34. 34.
    Cox L, Nelson H, Lockey R, Calabria C, Chacko T, Finegold I, et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol. 2011;127(1 Suppl):S1–55.CrossRefGoogle Scholar
  35. 35.
    Long A, McFadden C, DeVine D, Chew P, Kupelnick B, Lau J. Management of allergic and nonallergic rhinitis. Evid Rep Technol Assess (Summ). 2002;(54):1–6.Google Scholar
  36. 36.
    Broms P, Malm L. Oral vasoconstrictors in perennial non-allergic rhinitis. Allergy. 1982;37(2):67–74.CrossRefGoogle Scholar
  37. 37.
    Banov CH, Lieberman P. Vasomotor rhinitis study groups. Efficacy of azelastine nasal spray in the treatment of vasomotor (perennial nonallergic) rhinitis. Ann Allergy Asthma Immunol. 2001;86(1):28–35.CrossRefGoogle Scholar
  38. 38.
    Gawlik R, Jawor B, Rogala B, Parzynski S, DuBuske L. Effect of intranasal azelastine on substance P release in perennial nonallergic rhinitis patients. Am J Rhinol Allergy. 2013;27(6):514–6.CrossRefGoogle Scholar
  39. 39.
    Kaliner MA. Nonallergic rhinopathy (formerly known as vasomotor rhinitis). Immunol Allergy Clin N Am. 2011;31(3):441–55.CrossRefGoogle Scholar
  40. 40.
    Lieberman P, Meltzer EO, LaForce CF, Darter AL, Tort MJ. Two-week comparison study of olopatadine hydrochloride nasal spray 0.6% versus azelastinehydrochloride nasal spray 0.1% in patients with vasomotor rhinitis. Allergy Asthma Proc. 2011;32(2):151–8.CrossRefGoogle Scholar
  41. 41.
    Kaliner MA. Azelastine and olopatadine in the treatment of allergic rhinitis. Ann Allergy Asthma Immunol. 2009;103(5):373–80.CrossRefGoogle Scholar
  42. 42.
    Kaliner MA, Storms W, Tilles S, Spector S, Tan R, LaForce C, et al. Comparison of olopatadine 0.6% nasal spray versus fluticasone propionate 50 microg in the treatment of seasonal allergic rhinitis. Allergy Asthma Proc. 2009;30(3):255–62.CrossRefGoogle Scholar
  43. 43.
    Ratner PH, Hampel F, Van Bavel J, Amar NJ, Daftary P, Wheeler W, et al. Combination therapy with azelastine hydrochloride nasal spray and fluticasone propionate nasal spray in the treatment of patients with seasonal allergic rhinitis. Ann Allergy Asthma Immunol. 2008;100(1):74–81.CrossRefGoogle Scholar
  44. 44.
    Hampel F, Ratner P, Haeusler JM. Safety and tolerability of levocetirizine dihydrochloride in infants and children with allergic rhinitis or chronic urticaria. Allergy Asthma Proc. 2010;31(4):290–5.CrossRefGoogle Scholar
  45. 45.
    LaForce CF, Carr W, Tilles SA, Chipps BE, Storms W, Meltzer EO, et al. Evaluation of olopatadine hydrochloride nasal spray, 0.6%, used in combination with an intranasal corticosteroid in seasonal allergic rhinitis. Allergy Asthma Proc. 2010;31(2):132–40.CrossRefGoogle Scholar
  46. 46.
    Tan R, Corren J. Optimum treatment of rhinitis in the elderly. Drugs Aging. 1995;7(3):168–75.CrossRefGoogle Scholar
  47. 47.
    Meltzer EO, Bernstein DI, Prenner BM, Berger WE, Shekar T, Teper AA. Mometasone furoate nasal spray plus oxymetazoline nasal spray: short-term efficacy and safety in seasonal allergic rhinitis. Am J Rhinol Allergy. 2013;27(2):102–8.CrossRefGoogle Scholar
  48. 48.
    Vaidyanathan S, Williamson P, Clearie K, Khan F, Lipworth B. Fluticasone reverses oxymetazoline-induced tachyphylaxis of response and rebound congestion. Am J Respir Crit Care Med. 2010;182(1):19–24.CrossRefGoogle Scholar
  49. 49.
    Little D. Geriatric Rhinitis: under-diagnosed and undertreated. Geriatr Aging. 2005;8(5):52–3.Google Scholar
  50. 50.
    Mims JW. Epidemiology of allergic rhinitis. Int Forum Allergy Rhinol. 2014;4(Suppl 2):S18–20.CrossRefGoogle Scholar
  51. 51.
    Enright PL, Kronmal RA, Higgins MW, Schenker MB, Haponik EF. Prevalence and correlates of respiratory symptoms and disease in the elderly. Cardiovascular Health Study. Chest. 1994;106(3):827–34.CrossRefGoogle Scholar
  52. 52.
    Shargorodsky J, Garcia-Esquinas E, Galán I, Navas-Acien A, Lin SY. Allergic sensitization, rhinitis and tobacco smoke exposure in US adults. PLoS One. 2015;10(7):e0131957.CrossRefGoogle Scholar
  53. 53.
    Georgitis JW. Prevalence and differential diagnosis of chronic rhinitis. Curr Allergy Asthma Rep. 2001;1(3):202–6.CrossRefGoogle Scholar
  54. 54.
    Reiss M, Reiss G. Rhinitis in old age. Praxis (Bern 1994). 2002;91(9):353–8.CrossRefGoogle Scholar
  55. 55.
    Patterson CN. The aging nose: characteristics and correction. Otolaryngol Clin N Am. 1980;13(2):275–88.Google Scholar
  56. 56.
    Bende M. Blood flow with 133Xe in human nasal mucosa in relation to age, sex and body position. Acta Otolaryngol. 1983;96(1–2):175–9.CrossRefGoogle Scholar
  57. 57.
    Edelstein DR. Aging of the normal nose in adults. Laryngoscope. 1996;106(9 Pt 2):1–25.CrossRefGoogle Scholar
  58. 58.
    Dumas JA, Newhouse PA. The cholinergic hypothesis of cognitive aging revisited again: cholinergic functional compensation. Pharmacol Biochem Behav. 2011;99(2):254–61.CrossRefGoogle Scholar
  59. 59.
    Seiberling KA, Conley DB. Aging and olfactory and taste function. Otolaryngol Clin N Am. 2004;37(6):1209–28. viiCrossRefGoogle Scholar
  60. 60.
    Apter AJ, Mott AE, Frank ME, Clive JM. Allergic rhinitis and olfactory loss. Ann Allergy Asthma Immunol. 1995;75(4):311–6.PubMedGoogle Scholar
  61. 61.
    Sivam A, Jeswani S, Reder L, Wang J, DeTineo M, Taxy J, et al. Olfactory cleft inflammation is present in seasonal allergic rhinitis and is reduced with intranasal steroids. Am J Rhinol Allergy. 2010;24(4):286–90.CrossRefGoogle Scholar
  62. 62.
    Flurkey K, Stadecker M, Miller RA. Memory T lymphocyte hyporesponsiveness to non-cognate stimuli: a key factor in age-related immunodeficiency. Eur J Immunol. 1992;22(4):931–5.CrossRefGoogle Scholar
  63. 63.
    Murasko DM, Nelson BJ, Silver R, Matour D, Kaye D. Immunologic response in an elderly population with a mean age of 85. Am J Med. 1986;81(4):612–8.CrossRefGoogle Scholar
  64. 64.
    Naylor K, Li G, Vallejo AN, Lee WW, Koetz K, Bryl E, et al. The influence of age on T cell generation and TCR diversity. J Immunol. 2005;174(11):7446–52.CrossRefGoogle Scholar
  65. 65.
    Lages CS, Suffia I, Velilla PA, Huang B, Warshaw G, Hildeman DA, et al. Functional regulatory T cells accumulate in aged hosts and promote chronic infectious disease reactivation. J Immunol. 2008;181(3):1835–48.CrossRefGoogle Scholar
  66. 66.
    Sandmand M, Bruunsgaard H, Kemp K, Andersen-Ranberg K, Pedersen AN, Skinhøj P, et al. Is ageing associated with a shift in the balance between type 1 and type 2 cytokines in humans? Clin Exp Immunol. 2002;127(1):107–14.CrossRefGoogle Scholar
  67. 67.
    National Center for Health Statistics. Health, United States, 2012: With special feature on emergency care. Hyattsville, MD: Library of Congress Catalog Number 76–641496; 2013.Google Scholar
  68. 68.
    Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med. 2003;1(1):15–21.CrossRefGoogle Scholar
  69. 69.
    Schoenberg NE, Leach C, Edwards W. “It’s a toss up between my hearing, my heart, and my hip”: prioritizing and accommodating multiple morbidities by vulnerable older adults. J Health Care Poor Underserved. 2009;20(1):134–51.CrossRefGoogle Scholar
  70. 70.
    Nolte H, Nepper-Christensen S, Backer V. Unawareness and undertreatment of asthma and allergic rhinitis in a general population. Respir Med. 2006;100(2):354–62.CrossRefGoogle Scholar
  71. 71.
    Katotomichelakis M, Simopoulos E, Tzikos A, Balatsouras D, Tripsianis G, Danielides G, et al. Demographic correlates of anxiety and depression symptoms in chronic sinonasal diseases. Int J Psychiatry Med. 2014;48(2):83–94.CrossRefGoogle Scholar
  72. 72.
    Audino P, La Grutta S, Cibella F, La Grutta S, Melis MR, Bucchieri S, et al. Rhinitis as a risk factor for depressive mood in pre-adolescents: a new approach to this relationship. Pediatr Allergy Immunol. 2014;25(4):360–5.CrossRefGoogle Scholar
  73. 73.
    Nanayakkara JP, Igwe C, Roberts D, Hopkins C. The impact of mental health on chronic rhinosinusitis symptom scores. Eur Arch Otorhinolaryngol. 2013;270(4):1361–4.CrossRefGoogle Scholar
  74. 74.
    Wasan A, Fernandez E, Jamison RN, Bhattacharyya N. Association of anxiety and depression with reported disease severity in patients undergoing evaluation for chronic rhinosinusitis. Ann Otol Rhinol Laryngol. 2007;116(7):491–7.CrossRefGoogle Scholar
  75. 75.
    Barry LC, Allore HG, Guo Z, Bruce ML, Gill TM. Higher burden of depression among older women: the effect of onset, persistence, and mortality over time. Arch Gen Psychiatry. 2008;65(2):172–8.CrossRefGoogle Scholar
  76. 76.
    Beekman AT, Copeland JR, Prince MJ. Review of community prevalence of depression in later life. Br J Psychiatry. 1999;174:307–11.CrossRefGoogle Scholar
  77. 77.
    Erkul E, Cingi C, Özçelik Korkmaz M, Çekiç T, Çukurova I, Yaz A, et al. Effects of escitalopram on symptoms and quality of life in patients with allergic rhinitis. Am J Rhinol Allergy. 2012;26(5):e142–6.CrossRefGoogle Scholar
  78. 78.
    Becher A, Dent J. Systematic review: ageing and gastro-oesophageal reflux disease symptoms, oesophageal function and reflux oesophagitis. Aliment Pharmacol Ther. 2011;33(4):442–54.CrossRefGoogle Scholar
  79. 79.
    Achem SR, DeVault KR. Gastroesophageal reflux disease and the elderly. Gastroenterol Clin N Am. 2014;43(1):147–60.CrossRefGoogle Scholar
  80. 80.
    Schioler L, Ruth M, Jõgi R, Gislason T, Storaas T, Janson C, et al. Nocturnal GERD—a risk factor for rhinitis/rhinosinusitis: the RHINE study. Allergy. 2015;70(6):697–702.CrossRefGoogle Scholar
  81. 81.
    Hellgren J, Olin AC, Toren K. Increased risk of rhinitis symptoms in subjects with gastroesophageal reflux. Acta Otolaryngol. 2014;134(6):615–9.CrossRefGoogle Scholar
  82. 82.
    Duran J, Esnaola S, Rubio R, Iztueta A. Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr. Am J Respir Crit Care Med. 2001;163(3 Pt 1):685–9.CrossRefGoogle Scholar
  83. 83.
    Acar M, Cingi C, Sakallioglu O, San T, Fatih Yimenicioglu M, Bal C. The effects of mometasone furoate and desloratadine in obstructive sleep apnea syndrome patients with allergic rhinitis. Am J Rhinol Allergy. 2013;27(4):e113–6.CrossRefGoogle Scholar
  84. 84.
    Lavigne F, Petrof BJ, Johnson JR, Lavigne P, Binothman N, Kassissia GO, et al. Effect of topical corticosteroids on allergic airway inflammation and disease severity in obstructive sleep apnoea. Clin Exp Allergy. 2013;43(10):1124–33.PubMedGoogle Scholar
  85. 85.
    DeNavas-Walt C, Proctor BD, Smith JC. Income, poverty, and health insurance coverage in the United States: 2012. U.S. Census Bureau. Washington, DC: U.S. Government Printing Office; 2013. p. 60–245.Google Scholar
  86. 86.
    Banerjee S. Time trends in poverty for older Americans between 2001–2009. Washington, DC: Employee Benefit Research Institute; 2012. p. 20.Google Scholar
  87. 87.
    Andrade SE, Gurwitz JH, Fish LS. The effect of an Rx-to-OTC switch on medication prescribing patterns and utilization of physician services: the case of H2-receptor antagonists. Med Care. 1999;37(4):424–30.CrossRefGoogle Scholar
  88. 88.
    Mainardi T, Kapoor S, Bielory L. Complementary and alternative medicine: herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol. 2009;123(2):283–94. quiz 295–6CrossRefGoogle Scholar
  89. 89.
    Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States. Natl Health Stat Report. 2007;2008(12):1–23.Google Scholar
  90. 90.
    Kemper KJ, Vohra S, Walls R. Task force on complementary and alternative medicine; provisional section on complementary, holistic, and integrative medicine. American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics. Pediatrics. 2008;122(6):1374–86.CrossRefGoogle Scholar
  91. 91.
    Kapoor S, Bielory L. Allergic rhinoconjunctivitis: complementary treatments for the 21st century. Curr Allergy Asthma Rep. 2009;9(2):121–7.CrossRefGoogle Scholar
  92. 92.
    McFadden KL, Hernandez TD, Ito TA. Attitudes toward complementary and alternative medicine influence its use. Explore (NY). 2010;6(6):380–8.CrossRefGoogle Scholar
  93. 93.
    Baptist AP, Deol BB, Reddy RC, Nelson B, Clark NM. Age-specific factors influencing asthma management by older adults. Qual Health Res. 2010;20(1):117–24.CrossRefGoogle Scholar
  94. 94.
    Centers for Disease Control and Prevention. Self-reported increased confusion or memory loss and associated functional difficulties among adults aged >/= 60 years—21 States, 2011. MMWR Morb Mortal Wkly Rep. 2013;62(18):347–50.Google Scholar
  95. 95.
    Mathillas J, Lovheim H, Gustafson Y. Increasing prevalence of dementia among very old people. Age Ageing. 2011;40(2):243–9.CrossRefGoogle Scholar
  96. 96.
    Hebert LE, Weuve J, Scherr PA, Evans DA. Alzheimer disease in the United States (2010-2050) estimated using the 2010 census. Neurology. 2013;80(19):1778–83.CrossRefGoogle Scholar
  97. 97.
    Arlt S, Lindner R, Rösler A, von Renteln-Kruse W. Adherence to medication in patients with dementia: predictors and strategies for improvement. Drugs Aging. 2008;25(12):1033–47.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Allergy and Clinical ImmunologyUniversity of MichiganAnn ArborUSA
  2. 2.Division of Pulmonary, Critical Care, Sleep and Allergy, Department of MedicineUniversity of Illinois Hospital and Health Sciences SystemChicagoUSA

Personalised recommendations