A Growing Population of Older Adults with Sickle Cell Disease

Abstract

In countries with organized access to health care, survival of patients with sickle cell disease (SCD) has greatly improved, shifting the burden of care from a pediatrician to an internal medicine physician. As a consequence, cumulative disease complications related to chronic vasculopathy are becoming more apparent, adding to organ dysfunction from physiologic aging. The time has come for us to reevaluate the approach to managing the older adult with SCD by putting a greater emphasis on geriatric conditions while proactively considering curative options once previously offered only to younger patients, with comprehensive annual assessments and joint clinics with relevant specialists.

Keywords: Aging- and disease-related morbidities; Curative therapies; Disease-modifying therapies; Sickle cell disease.

Fig. 1.

A proposed model of managing SCD in the older adult. (A) The traditional single disease focused framework of comorbidity where comorbid conditions are considered as disease pairs, such as SCD and diabetes mellitus, SCD and cardiovascular disease, and SCD and dementia. Most clinical practice guidelines are based on this framework. (B) Multimorbid conceptual framework demonstrating a more patient-centric approach to managing the older adult with SCD in the context of multiple chronic conditions, geriatric syndromes, functional status, and social determinants of health. CKD, chronic kidney disease; CNS, central nervous system; CVD, cardiovascular disease; DM, diabetes mellitus.