Prevention of cardiovascular disease and dementia in old age

Cardiovascular diseases (CVD), together with dementia, are causing the highest burdens of disease in people aged 65 years and over. Prevention of these diseases in older people is an opportunity to further reduce the global disease burden. This thesis aimed to increase the knowledge on preventive strategies specifically tailored towards older people.
Part I, cardiovascular risk management. A CVD risk prediction models for older people was developed and predictive ability of traditional risk factors in older people was evaluated and put into a broader context in a systematic review. In older age, traditional risk factors had less predictive value for CVD compared to mid-life. An intervention study showed that nurse-led intensive vascular care resulted in stronger reductions in SBP and lower smoking rates compared to standard care, but did not affect the overall CVD risk profile, nor did it reduce CVD morbidity or mortality rates. A qualitative study showed that older people do not feel sufficiently involved in decision making about hypertension management in general practice, while they have unexpressed concerns. We advise the GP to break this silence, to facilitate shared decision-making on hypertension management and improve tailored care.
Part II, dementia prevention. Routinely collected data from Dutch primary care networks on 800.000 persons and over 23.000 incident dementia cases showed an overall increase in age-standardized dementia incidence rates of 2.1% per year between 1992 and 2014. Changes in dementia incidence have been attributed to changes in risk factor occurance on the population level over the past decades.