AGEING ARTERIES AND FRAGILE LEGS: PERIPHERAL ARTERY DISEASE IN OLDER ADULTS

Abstract

Peripheral artery disease is a common manifestation of systemic atherosclerosis and contributes to impaired mobility and functional decline in older adults. In this population, peripheral artery disease rarely occurs in isolation and commonly coexists with multimorbidity, frailty, sarcopenia, malnutrition, cognitive impairment, depression, visual impairment, and reduced physical capacity. These coexisting conditions may alter the clinical presentation of peripheral artery disease, compromise engagement in exercise therapy, impair foot inspection and protection, delay recognition of tissue injury, and contribute to poorer physical function, loss of independence, and lower health related quality of life. This narrative review examines peripheral artery disease in older adults through the interplay between vascular insufficiency and geriatric vulnerability. The review was based on a focused synthesis of recent clinical guidelines, consensus documents, systematic reviews, meta analyses, and selected clinical studies, with particular emphasis on functional impairment, frailty, sarcopenia, exercise therapy, cognitive impairment, depression, preventive foot care, and wound healing. Structured exercise, particularly intermittent walking, remains a central component of non pharmacological management in chronic symptomatic peripheral artery disease. In older adults, frailty, sarcopenia, impaired mobility, comorbidities, and cognitive difficulties may reduce the feasibility of conventional walking based programmes. The exercise modality, intensity, and level of supervision should therefore be adapted to the patient’s functional capacity and tolerance. Preventive foot care and early recognition of tissue injury are important components of peripheral artery disease management. In older adults, practical barriers such as visual impairment or difficulty reaching the feet may compromise regular foot inspection and routine care. Non
healing wounds require early vascular assessment and coordinated management, including revascularisation when feasible, infection control, pressure offloading, and local wound care. Assessment should therefore address the patient’s practical capacity for self care and the need for additional support from family members, caregivers, or a multidisciplinary team. Cognitive impairment and depression may further influence adherence, self management, and participation in treatment. Cognitive difficulties can interfere with the understanding and recall of recommendations concerning exercise, medication, and foot protection, while depression may reduce motivation and engagement in physical activity and preventive care. Communication and treatment plans may therefore need to be simplified and reinforced when cognitive or physical limitations restrict the patient’s ability to implement recommendations in daily life. Management of peripheral artery disease in older adults should extend beyond vascular disease and include functional ability, geriatric vulnerability, capacity for daily self care, and available support. Incorporating these factors into clinical decision making may help align treatment goals and management strategies with each patient’s needs and priorities, thereby supporting mobility, independence, and quality of life.