Geriatric Rhinitis

Rhinitis refers to inflammation of the mucosal tissues lining the nasal passages. Though this can occur in any age group for a variety of reasons, geriatric rhinitis – rhinitis in those over the age of 60 years – comes with some specific considerations.

Symptoms of Geriatric Rhinitis

Rhinitis symptoms in older individuals are largely the same as for people of any age. The symptoms of geriatric rhinitis can include:

• Persistent post-nasal drip
• Nasal congestion, particularly when lying down
• Constantly feeling the need to clear the throat
• Crusting around the nose
• The vague sensation of pressure around the face
• Decreased sense of smell or taste

Some patients with geriatric rhinitis may also report experiencing sinus infections or frequent nosebleeds.

Geriatric Rhinitis Types and Causes

A few underlying age-related factors may contribute to geriatric rhinitis, such as changes to anatomical structures around the nose, an aging immune system, and hormonal imbalances. There are three types of rhinitis in the elderly.

Allergic rhinitis

As the name suggests, there is an allergic component underlying this form of geriatric rhinitis. When the body encounters an allergen, such as dust mites, pet dander, or pollens, the immune system overreacts to this harmless substance, leading to the common symptoms of allergy. Sufferers of allergic rhinitis may experience episodes only during certain seasons if their allergen is something like grass pollen, or they can experience symptoms throughout the year in the case of perennial allergens, such as cockroaches.

Characteristic symptoms of allergic rhinitis include:

• Nasal congestion
• Runny nose
• Itching around the nose and eyes
• Sneezing
• Post-nasal drip

There are conflicting results from studies about the prevalence of allergic rhinitis in the elderly population. One study reported the risk of allergic rhinitis seems to decrease with older age, while another study found that the prevalence of allergic rhinitis in older people is the same as in younger adults.

Non-allergic rhinitis

Non-allergic rhinitis causes many of the same symptoms as the allergic subtype – post-nasal drip, runny nose, and congestion – but without the underlying allergic causes. Instead, other triggers of rhinitis episodes often reported may include:

• Strong smells
• Cold air
• Changes in weather
• Pollutants
• Chemicals and certain medications
• Physical exercise

Because of this, non-allergic rhinitis symptoms are not necessarily restricted to certain seasons but can be persistent or occur at random throughout the year. Non-allergic rhinitis is most common in elderly adults when compared to younger age groups.

Instances of non-allergic rhinitis may occur alongside allergic rhinitis. Between 44-87% of individuals with allergic rhinitis will also exhibit symptoms to triggers not associated with allergy, such as changes in humidity.

Atrophic rhinitis

With older age, decreased blood circulation to the mucosal lining of the nasal passages leads to atrophy of these tissues – the mucosa dries and shrinks away. Although shrinking of the mucosal tissue results in an expanded nasal cavity, atrophic rhinitis is characterized by:

• Nasal congestion
• Crusting around the nose
• Foul odor from the nose

Patients with allergic or non-allergic rhinitis can also have components of the atrophic subtype.

Management of Geriatric Rhinitis

Managing rhinitis effectively in elderly people can be challenging for several reasons. One is that older people are more likely to be diagnosed with more health conditions and are more likely to be taking multiple drugs for these illnesses. In the US, almost half of people aged 65 years or older are taking at least five medications every day. Not only do these medications potentially contribute to rhinitis in these individuals, but adding even more drugs to manage rhinitis is not ideal. This increases the daily burden on a person and also comes with the risk of complicated drug interactions. Several medications known to cause or contribute to rhinitis include non-steroidal anti-inflammatories, beta-blockers, diuretics, and antidepressants.

Certain illnesses among the elderly appear to be commonly associated with rhinitis, although how this relationship is formed is not always clear. In particular, depression is highly prevalent in older people and has been associated with symptoms of rhinitis in several studies. Gastroesophageal reflux disease (GERD) is another common condition found in older patients with studies noting an increased risk of concurrent rhinitis symptoms. Obstructive sleep apnea (OSA) has also been found to be associated with rhinitis in older patients. Studies have found that treatment for allergic rhinitis incidentally also improved OSA symptoms, though further research is needed to consolidate these findings.

Non-medical treatments

In some situations, something as simple as avoiding the offending allergen or trigger can be enough to sufficiently reduce symptoms of geriatric rhinitis. Some patients may find rinsing out the nasal cavity with a saline wash can help to relieve the discomfort during rhinitis episodes.

Medications

Medications for managing geriatric rhinitis include corticosteroid nasal sprays, antihistamines, and anticholinergic nasal sprays. If there is an infection present in atrophic rhinitis cases, an antibiotic can be useful. However, due to the potential for interaction with other medications, elderly individuals should have their medical history reviewed by a doctor before using any of these drug treatments, even if they are easily accessible over the counter at drugstores or grocery stores.

Surgery

If there are problems such as deviated septum or dysfunction of the turbinates in the nose that are contributing to rhinitis, an ENT (ear, nose, throat) specialist may be able to address this with surgery.

Geriatric rhinitis is a common condition among the elderly but is often overlooked due to the myriad of other, more pressing health issues in this age group. However, effectively treating rhinitis has the potential to improve quality of life, so if you’re experiencing the symptoms of rhinitis, don’t ignore it.