Between 2010 and 2020, the population of adults over the age of 65 saw the largest and fastest growth in any decade and reached 55.8 million, or 16.8 percent of the total U.S. population.1 Further, the number of older Americans is projected to nearly double by 2060,2 with those age 85 and older expected to nearly quadruple between 2000 and 2040; many of these people have multiple chronic conditions (MCCs) and complex health and social needs.3
To ensure effective treatments and improved health outcomes among older adults, it is essential to understand and address the unique challenges of accurate and timely diagnosis for this group. Misdiagnosis or delayed diagnosis is a public health challenge and is estimated to affect at least 1 in 20 U.S. adults, with the potential to lead to severe harm in about 6 million outpatients per year.4 It can lead to inappropriate treatments, disease progression, preventable hospitalizations, and other adverse outcomes.
Older adults are at higher risk for diagnostic errors than younger adult populations for multiple reasons, including:
- Multiple coexisting conditions.
- Atypical presentations of common diseases.
- Stereotypes about aging (i.e., attributing symptoms warranting evaluation to aging).
- Complications from medications.
- Communication barriers due to cognitive or sensory impairments.5,6
Comorbidities and multiple medications (i.e., polypharmacy) can mask or mimic symptoms of other diseases, ultimately leading to misdiagnosis or delayed diagnosis. For many diseases, older adults may present atypically, thus contributing to additional difficulties for clinicians to make timely and accurate diagnoses.
Common geriatric syndromes such as frailty, dementia, delirium, falls, and incontinence may complicate the diagnostic process by making it difficult to distinguish new acute problems from exacerbations of chronic symptoms of existing diseases. At times, these problems go undiagnosed. Furthermore, health-related social needs and other social factors can present barriers to accessing timely services and diagnostic testing.
This issue brief presents the unique considerations and challenges of studying and improving diagnostic safety for older adults. A number of recent expert workgroups have identified key areas of focus for diagnostic safety research and improvement efforts.6-9 However, few efforts exist to summarize existing literature focused on understanding and addressing diagnostic errors in older adult populations, particularly with the objective of identifying opportunities for improvement. We summarize the state of the science around the diagnostic process in older adults, focusing on unique challenges, followed by selected recommendations for practice improvement, research, and policy to reduce the risk of diagnostic error.
