Breathlessness in Older Adults

What We Know and What We Still Need to Know

Eralda Hegendörfer MD, PhD; Jean-Marie Degryse MD, PhD


J Am Geriatr Soc. 2023;71(7):2082-2095. 

In This Article

Abstract and Introduction


Breathlessness is common among older adults, but it is often hidden as "normal aging "or considered narrowly as a symptom of cardio-respiratory diseases. Studies on breathlessness in older adults are mostly focused on specific diseases, whereas older adults are characterized by multimorbidity and multi-system age-related impairments. This article aims to provide an overview of what is known so far on breathlessness in the general population of older adults and identify areas for further research. Research shows that breathlessness in older adults is a multifactorial geriatric condition, crossing the borders of system-based impairments and diseases, and a valuable independent prognostic indicator for adverse outcomes. Further research needs to investigate (1) the multi-factorial mechanisms of breathlessness in community-dwelling older adults including the role of respiratory sarcopenia; (2) the influence of affective and cognitive changes of older age on the perception and report of breathlessness; (3) the best way to assess and use breathlessness for risk prediction of adverse outcomes in general geriatric assessments; and (4) the most appropriate multi-modal rehabilitation interventions and their outcomes. Clinicians need to shift their approach to dyspnea from a disease symptom to a multifactorial geriatric condition that should be proactively searched for, as it identifies higher risk for adverse outcomes, and can be addressed with evidence-based interventions that can improve the quality of life and may reduce the risk of adverse outcomes in older adults.


In recent years, there has been increasing interest and calls for a systematic assessment of breathlessness in the general adult population as it is prevalent, provides valuable general prognostic information, its assessment requires minimal efforts and there are evidence-based interventions for its relief.[1–4]

Community-dwelling older adults are a special population regarding breathlessness as its prevalence increases with age, yet it is commonly hidden and attributed to "normal aging".[2,4] In addition, older adults are characterized by multimorbidity, age-related multi-system low physiological reserves, and reduced symptom perception and reporting.[2,4,5]

This article aims to provide an overview of the current research findings on breathlessness in the general population of older adults and identify potential areas for future research about its underlying causes, prognostic role, assessment, and management in general geriatric care.

The terms breathlessness and dyspnea are both used in medical literature and in this article, we use them interchangeably. Dyspnea (literal meaning 'disordered breathing') is defined as a "subjective experience of breathing discomfort",[6] but it is not a term used by patients, whereas breathlessness is more commonly used by patients and clinicians to describe breathing difficulty or discomfort.[4,7]