Aging and Hemophilia

By Hilary Hamilton

February 2022

People with bleeding disorders now face the same age‑related medical conditions as the general population. Advancements in the development of comprehensive hemophilia treatment centres and the implementation of home treatment have increased the life expectancy for people living with hemophilia. It is best to stay informed and maintain a close relationship with your hemophilia treatment team as new challenges associated with aging occur and collaboration with physicians in different specialties may be needed to provide optimal care.

Joint Disease

Treating prophylactically with factor replacement therapy to prevent bleeding episodes has been the standard of care for persons with severe hemophilia in first‑world countries since the early 1990s. However, adults aged 65 and older with hemophilia did not have any access or were limited to the availability of on‑demand treatment throughout their childhood and into their adult years. As a result, hemophilic arthropathy in elbows, knees, and ankles is common. This can cause pain, reduced range of motion, joint deformity, and muscle weakness.

joint disease
  • Physiotherapy and rehabilitation. Physical therapy and rehabilitation for the management of patients with hemophilia refers to the use of flexibility, strength training, balance, and functional exercises to restore or preserve joint and muscle function.
  • Pain management. Acute pain due to a joint or muscle bleed may be treated with immediate administration of clotting factor concentrates to stop bleeding, pain medication, and adjunctive measures such as immobilization, compression, and splinting to minimize pain, if appropriate.

Viral Disease

Viral inactivation of plasma‑derived factor concentrates was not introduced until 1985. Prior to this, viral infections such as HIV and hepatitis C were commonly contracted among people with hemophilia. Even with advancements in anti‑viral treatment for both infections, older hemophiliacs may continue to experience chronic liver or kidney‑related health conditions from disease progression that may already have occurred.

Viral disease
  • Routine screening. Regular blood tests, liver functions tests, or biopsies may be necessary.
  • Monitor your symptoms. Symptoms for chronic liver and kidney disease can be mild and may be easily missed.
  • Avoid alcohol, smoking, and illegal drugs. These substances can hard for your liver and kidney to metabolize/process and excrete/remove from your body.
  • Know your medications. Talk to your hemophilia treatment team or pharmacist before you take any new medicine.
  • Healthy eating. Eat a healthy diet and stay at a healthy weight. Limit sugar, salt, and potassium. Eat meals low in fat and cholesterol.
  • Stay informed. Become an advocate for your own health by asking questions, researching, and finding out what resources are available.

Cardiovascular Disease

Persons with hemophilia have a significantly higher prevalence of high blood pressure (hypertension) compared to the general population. There is also evidence that people with hemophilia develop plaque build‑up in the arteries (atherosclerosis) at similar rates to those in the general population and individuals with severe, moderate, and mild hemophilia may develop overt ischemic heart disease.

Regular check‑ups and routine measures for cardiovascular screening and risk‑reduction are important for early detection and management of any signs or symptoms.

cardiovascular disease
  • Control your blood pressure
  • Keep your cholesterol and triglyceride levels under control
  • Stay at a healthy weight
  • Eat a healthy diet
  • Get regular exercise
  • Limit alcohol
  • Don’t smoke
  • Manage stress
  • Manage diabetes
  • Make sure you get enough sleep

Mental Health

Additional health problems, chronic pain, and frequent hospital visits or appointments with your doctor can impact your emotional and mental health. It can be overwhelming, and you may begin to struggle with feeling down, fear of what may come next, anger, or frustration. These feelings can be common for people living with chronic conditions as they age.

Mental health
  • Educate yourself. Learn about the ailments and diseases that affect your health and life. This will help you feel empowered and be able to advocate for yourself.
  • Write down questions. Keep an ongoing list of questions about your symptoms to help remind you of what you would like to discuss with your physician or other healthcare providers.
  • Decrease stress in your life. Stress can manifest in many different ways and can have a negative impact on your immune system and blood pressure.
  • Open communication between the members of your medical team. Develop a relationship with your hemophilia treatment team and always ask for help when you need it.
  • Laugh often. Surround yourself with people you love or do activities you enjoy.

It is important that you have access to health education and preventative strategies to reduce the risk or impact of age‑related conditions. Talk to your healthcare team about ways to remain healthy and vital as you age.

About the Author

Hilary Hamilton

Hilary is a Registered Nurse at the Northern Alberta Bleeding Disorders Clinic. She received her Bachelor of Science in Nursing in 2009 from the University of Alberta. She is responsible for the assessment, planning, implementation, and coordination of patient care for adult and pediatric patients with bleeding and rare blood disorders. She works closely with patients on home infusion programs. Hilary is an active liaison and educational resource regarding bleeding disorders for patients, their family members, other health care professionals, and the community.