Elderly, 14 million over 65s in Italy: geriatric radiology for personalized prevention

Italy confirms itself as one of the oldest countries in the world: there are 14.4 million people over 65 – that is, a quarter of the population – and in the next 20 years they will reach almost 19 million, over a third of the citizens. Among them, the over 80s will occupy a significant part: if today they are 4.6 million, it is estimated that in 2043 they will be over 6 million. These are the data collected by the 2025 ISTAT Annual Report, which the SIRM (Italian Society of Medical and Interventional Radiology), in collaboration with the SIGG (Italian Society of Gerontology and Geriatrics) highlighted to send an important message: it is urgent to focus on the prevention of pathologies typical of the elderly and adapt imaging protocols to take their characteristics into account. The topic was discussed during the conference Geriatric Radiology, a new clinical-radiological approach to an 'old' problem, held in Rome.

A country of old people

"Italy is one of the longest-lived countries and will be even longer in the coming years, but getting older often means developing pathologies, which is why we believe it is urgent to review, from a radiological and semiotic point of view, the protocols that can help prevent some of the main diseases that can compromise the quality of life of the elderly - explains Nicoletta Gandolfo , President of SIRM. Let's take osteoporosis as an example, one of the most widespread pathologies in old age: an early diagnosis allows us to act with therapies that prevent fractures, instead of treating them once they have already occurred. This concept can also be applied to sarcopenia, degenerative cardiovascular diseases and other typical pathologies of the elderly. People who live longer also have high expectations regarding health: they want to live a full and quality life. The concept of 'pathological' must be adapted to the age of the patient: what can only be buffered at 80, can and must be treated at 40, because the person could be a candidate for developing a much more serious clinical picture as time goes by. This is why personalized imaging protocols are needed, which take into account the physiological changes of people, to obtain a correct global geriatric assessment. We must consider physical function, cognitive status and social conditions. All of this must contribute not only to preventing pathologies and making early diagnoses, but also to avoiding unnecessary overdiagnosis, so as not to subject the elderly patient to too many invasive and stressful tests, especially in situations where it would not be appropriate to intervene. This is then also reflected in the costs borne by the National Health System, in a broader discussion of sustainability.”

The role of preventive radiology

Prevention, therefore, to then cure better and, hopefully, even less. Preventive and personalized imaging plays an important role: “Diagnostic imaging can be used to identify early signs of many pathological conditions linked to frailty. The goal must be to intervene on risk factors so that they do not become the pathological event. The elderly use radiology much more than young people and require a complete evaluation and not a compartmentalized one. For this reason, we must implement more and more barrier-free pathways, support in the case of cognitive disorders and attention to contrast media, to which the over 65s may be more sensitive”.

What is Geriatric Radiology?

"Fragility is not always synonymous with old age - explains Stefania Montemezzi , President and Coordinator of the SIRM Diversity, Equity and Inclusion Commission -, which is why it is important to pay attention to healthy aging, to the benefit of both the patient and those close to them and the National Health Service. Today, radiology can help prevent the main pathologies of the elderly such as heart attacks, strokes, fractures and tumors through the use of diagnostic imaging, which allows for risk stratification and early identification of factors that can lead to major acute events. As SIRM, we have organized courses focused on geriatric radiology, a new branch of the profession, which will take place in Lombardy, Tuscany and Calabria, aimed specifically at radiologists to delve into this topic and allow knowledge to spread to every healthcare facility. In the near future, we will have to deal with problems related to the aging of the population, such as the increase in the number of emergency room visits, the spread of chronic diseases, the need for beds and the increase in hospitalizations. This is why we believe that training radiologists is truly necessary. Last year, again as SIRM, we launched Il radiologo medico, un amico dell' anzianiano, the first pilot study/national prevention project promoted by our scientific society exclusively aimed at seniors, demonstrating the great commitment that we believe is necessary towards this part of the population.”