North America is in the midst of a major shift in demographics. The mean age of the population is increasing significantly, and the fastest growth is in the age group of 65 years of age and older. In the United States, over 40% of noninterest federal government spending goes to this segment of the population, with a large portion spent on their medical care.<sup>143 Samuelson R.J. Sowing more cynicism Newsweek October 24, 1994 ;  45 : 1994.

Cliccare qui per andare alla sezione Riferimenti, 167 Staff reporter. Time October 15, 1993

Cliccare qui per andare alla sezione Riferimenti</sup> The greatest growth is seen in the over age-85-group, the so-called “very elderly,” “old-old,” or “oldest old,” caused by significant declines in this specific subset.<sup>106 Manton K.G., Soldo B.J. Dynamics of health changes in the oldest old: New perspectives and evidence Milbank Memorial Fund Quarterly 1985 ;  63 : 206-285  [cross-ref]

Cliccare qui per andare alla sezione Riferimenti</sup> The population of the elderly will increase approximately fourfold through 2030, whereas the population of the young will increase little. The elderly group consumes most health care resources. Cardiovascular disease (CVD) is the commonest cause of morbidity and mortality in the elderly; however, surprisingly few cardiovascular therapies have been studied systematically in trials in this group.<sup>58 Gurwitz J.H., Col N.F., Avorn J. The exclusion of the elderly and women from clinical trials in acute myocardial infarction JAMA 1992 ;  268 : 1417-1422

Cliccare qui per andare alla sezione Riferimenti</sup> In fact, until recently, older and particularly elderly patients were systematically excluded from therapeutic trials. As a result, cardiovascular specialists are the least prepared to deal with the one group that includes most patients with CVD and that has the most rapid growth.

Early physiologists recognized that hearts from older persons were stiff. We now know that the most substantial changes in left ventricular (LV) function with aging occur in diastolic function, not in systolic function. Aging changes in diastolic function have broad implications for cardiovascular health in the elderly. In addition, a large proportion of cardiovascular disorders in the elderly are associated with abnormal diastolic function. Consequently, geriatric cardiology and diastolic function are intertwined.

This article examines normal age-related changes in cardiovascular function with particular emphasis on diastole, the implications of these changes, and pathophysiology, epidemiology, diagnosis, and therapy of specific disorders involving diastolic dysfunction in the elderly.