Venous thromboembolism (VTE) is a complex condition consisting of deep vein thrombosis (DVT) and pulmonary embolism (PE). In the younger population, the annual rate of growth of venous thromboembolism is relatively low, about 1;However, with increasing age, this growth rate increases significantly in the older population, reaching 6 8. It is important to note that about 60% of venous thromboembolism occurs in the elderly population over 65 years of age, and this proportion is increasing with age. This means that age is an important risk factor that requires special attention.
Epidemiology and risk factors for venous thromboembolism in older adults1. Epidemiological characteristics of venous thromboembolism in the elderly population: 1. Incidence of venous thrombosis in the elderly population. At present, there are few studies on the incidence of venous thromboembolism in large populations in China, while data on large sample sizes abroad show that the annual incidence of venous thrombosis in European populations is between 104‰～1.83. However, the incidence of venous thromboembolism in China has increased year by year, from 028 gradually climbed to 048‰。It is worth noting that the incidence of venous thromboembolism increases exponentially with age, with an annual incidence of less than 1 in people aged 50 and as high as 6 8 in people over 80 years old. In addition, the incidence of venous thrombosis in people over 75 years of age is 7 to 10 times higher than that of adults under 50 years of age. 2. Mortality rate in elderly patients with venous thromboembolism. Previous data have shown that the 30-day and 1-year mortality rates of venous thromboembolism in the elderly were 10., respectively6% and 230%。However, because only some of the fatalities are correctly diagnosed before death, the mortality rate of venous thromboembolism in the elderly population may be as high as 30% within 30 days after combining autopsy data, and the cause of death is mostly pulmonary embolism. In a multicenter study in China, the mortality rate of venous thromboembolism remained at 8., although it decreased after the implementation of the National Venous Thromboembolism Prevention and Control Program (NCPPT).A high of 7%. Even so, the proportion of pulmonary embolism and associated mortality in older venous thromboembolism is significantly higher than in younger patients. 2. Risk factors for venous thromboembolism in the elderly In recent years, advanced age has been widely recognized as an independent risk factor for venous thromboembolism. As older people age, they may accumulate multiple risk factors that increase their risk of venous thromboembolism. In elderly patients, several different risk factors can usually be identified: 1. Changes in blood vessels and coagulation function caused by aging. With the increase of age, the blood vessel wall gradually ages, the collagen content increases, and the elastin disorder and rupture lead to spontaneous endothelial damage, which may be one of the reasons for the high incidence of venous thromboembolism in the elderly. 2. Trauma, surgery and immobilization. These factors may contribute to vascular injury, activation of the coagulation system, and slowing venous blood flow to the lower extremities during immobilization, which are important risk factors for venous thromboembolism. Thrombosis often occurs in various immobilization states, such as various traumas, after surgery, serious illness in bed, fractures, disability, long-term wheelchair conversion, etc. Due to osteoporosis, malignant tumors and other reasons, the elderly are more likely to suffer from high-risk factors such as fractures, trauma, and surgery that cause blood clots, so they are more likely to suffer from venous thromboembolism. 3. With the increase of age, the incidence of underlying internal medicine diseases and malignant tumors also increases, and these diseases are closely related to the occurrence of thrombosis. Therefore, hospitalized medical patients, particularly older patients, should be considered at high risk for venous thromboembolism. At the same time, the relationship between malignant tumors and thrombosis is complex and close, and venous thromboembolism is not only a common complication in cancer patients, but also sometimes a sign and signal of occult tumors, especially in elderly cancer patients, which should be paid special attention to. 
Risk assessment of venous thromboembolism in older adultsThe risk of venous thromboembolism increases significantly with age, and older adults may further increase the likelihood of thrombosis due to a variety of underlying problems. Malignant tumors are often in a hypercoagulable state, and about 19% to 30% of patients with venous thromboembolism have malignant tumors, and it is not uncommon for elderly patients with venous thromboembolism to develop malignant tumors and occult cancers. Oncological surgery** and chemotherapy are also high-risk factors for the development of venous thromboembolism. There is a significant linear relationship between high body mass index (BMI) and the occurrence of venous thromboembolism in the elderly, and the risk of thrombosis in obese elderly people is more than twice that of non-obese elderly people. Other risk factors for venous thromboembolism in older adults include a history of previous thrombosis, prolonged immobilization or bed rest, thrombophilia, recent trauma, surgery, acute myocardial infarction, acute ischemic stroke, acute infectious disease, rheumatic disease, inflammatory bowel disease, diabetes mellitus, and hormone use. China has entered an aging society, and the elderly group is huge, including hospitalized elderly patients and ordinary elderly groups such as home and nursing institutions, all of whom are high-risk groups for venous thromboembolism. Therefore, it is necessary to arouse the extensive attention and attention of the whole society. There is an urgent need to develop a simple and effective risk assessment model, which can not only score the specific risk of the elderly, but also effectively screen the high-risk groups of venous thromboembolism through the early warning of risk factors, so as to formulate corresponding preventive measures, referral recommendations or further examinations. This will effectively improve the prevention and treatment efficiency of venous thromboembolism and reduce the social and medical burden. 
Clinical manifestations of venous thromboembolism in the elderly1. The elderly with deep vein thrombosis suffer from this disease mostly in the lower limbs, and the symptoms are mild, and patients over 80 years old often have no typical symptoms. Hospitalized, bedridden, wheelchair and disabled people are at high risk of acute deep vein thrombosis, and the main symptoms include limb swelling, pain, increased tension, and some patients also feel a feeling of heaviness in the lower limbs. However, older people have decreased sensory function and less walking, and these symptoms are usually milder than those of younger people. On physical examination, the limbs may be red, the veins are dilated, the skin temperature is elevated, and tenderness may be along the venous thrombosis. If the thrombus is located in the intermuscular plexus of the lower leg, tests are often positive, and patients with severe lower extremity deep vein thrombosis may present with extremely elevated limb tone and ischemia. In the chronic phase, deep vein post-thrombotic syndrome can occur, which is mainly manifested as positional swelling and pain, and the signs include edema in the ankle area, pigmentation, eczema, varicose veins, and even sclerosis and ulcers in severe cases. 2. Pulmonary embolismPulmonary embolism is a common acute disease in the elderly, and its clinical manifestations are closely related to the size of the thrombus, the location of the obstruction and the basic condition of the patient. Symptoms and signs of pulmonary embolism tend to be atypical in older people than in younger patients. Typical symptoms such as chest pain, hemoptysis, and dyspnea are rare, and signs and symptoms such as syncope and pulmonary rales are more common. In terms of physical signs, there is no significant difference between elderly and non-elderly patients with pulmonary embolism, and common signs include fever, rapid breathing, and increased heart rate. Pulmonary embolism is not regularized** can cause chronic pulmonary hypertension and needs to be taken seriously. Some of the common symptoms may include:- Shortness of breath or fatigue after exertion, which may indicate that the heart is overloaded. - Difficulty breathing, chest tightness, and chest pain may also be associated with heart problems. - Edema of the lower extremities may indicate impaired heart function and fluid buildup in the legs. - Not being able to lie flat at night can be due to congestion in the lungs or difficulty breathing due to heart problems. In addition, if you have pulmonary hypertension problems in older adults, a mean pulmonary artery pressure of more than 25mmHg at rest may affect right heart function, leading to heart failure. Keep in mind that these symptoms can be part of many different conditions, and if you have any concerns, it's best to consult a doctor or medical professional for a proper diagnosis and advice. In some cases, these symptoms can be early signs of a serious illness that require immediate attention and appropriate attention**. 
Drugs for venous thromboembolism in the elderly**1. Anticoagulation** Since the elderly often have a variety of diseases, they are not obviously representative in the study of various venous thromboembolism. Therefore, the optimal regimen for venous thromboembolism** in older adults and the duration of anticoagulation have not been established. Data show that about 30% of elderly patients with venous thromboembolism are excluded from clinical studies of vitamin K antagonists. This is mainly because they have a 2-fold increased risk of bleeding relative to the unexcluded population. Although existing guidelines do not make specific recommendations for specific regimens and duration of anticoagulation in older adults, they do take age into account and do not require prolonged anticoagulation in patients with no obvious cause and a high risk of bleeding**. 2. Thrombolysis** is still controversial in elderly patients with pulmonary embolism. Because older patients have a higher risk of bleeding, systemic thrombolysis is not the preferred option. The pressure** of venous thromboembolism in the elderly includes elastic bandages, gradient compression stockings, etc. These methods are effective in relieving symptoms and preventing blood clots from getting worse. 3. The endoluminal treatment of venous thromboembolism in the elderly at home should be selected after individualized assessment according to the location of thrombus involvement, the severity of clinical manifestations, and the time of thrombosis. The elderly outside the hospital (home, nursing institutions, communities, etc.) are an important part of the prevention and treatment of venous thromboembolism. In the home, nursing institutions and non-inpatient environments, the information management of thrombosis prevention and treatment for this population is particularly important. In summary, the elderly, especially the elderly at home, in nursing institutions and non-hospitalized elderly people, are the weak groups in the prevention and treatment of venous thromboembolism. They have a higher prevalence and a higher risk of avoidance of ** hormones, so we need to strengthen the prevention and control of this population and improve their health. At present, there is insufficient evidence or evidence for the prevention and development of thrombosis in this population. The diagnosis and ** of venous thromboembolism in the elderly population refer to most relevant domestic and foreign guidelines and consensus for hospitalized older adults. We hope that this knowledge will be helpful in the prevention and treatment of thrombosis in hospitalized and non-hospitalized older adults, especially in regulating the prevention and treatment of venous thromboembolism in non-hospitalized older adults. Our goal is to provide guidance and recommendations for improving the quality of life and quality of life of older adults. However, further research and exploration are needed to provide more specific and targeted prevention and ** strategies. 
References1. Elderly patients with acute venous thromboembolism should actively look for relevant risk factors, including removable and non-removable. This includes removable risk factors for surgery, trauma, fractures, acute medical illness, immobilization, and other factors, as well as non-removable risk factors for malignancy, antiphospholipid antibody syndrome, inflammatory bowel disease, nephrotic syndrome, etc. 2. For elderly patients with venous thromboembolism without obvious causes, it is recommended to screen for sex-specific malignant tumors instead of routine extensive screening, especially for routine thrombophilia. 3. Elderly patients with familial venous thromboembolism and no exact reversible predisposing factors are recommended to be screened for thrombophilia. 4. According to the risk level of venous thromboembolism in elderly patients, the risk of thrombosis is low-risk elderly people, and their preventive measures are mainly health education and encouraging activities, and mechanical prevention can also be chosen. In older adults with an intermediate or high risk of thrombosis, mechanical prophylaxis alone is recommended if anticoagulation is contraindicatedIn older adults at high risk of thrombosis who are not contraindicated to anticoagulant use, a combination of mechanical prophylaxis and pharmacological prophylaxis is recommended. 5. Basic prevention is the most basic method to prevent venous thromboembolism. Reasonable diet is the key to basic prevention: (1) Eat more seasonal vegetables, beans, whole wheat flour and other foods rich in dietary fiber to keep the stool smooth. (2) Drink more water, about 1500 ml of water per day, and reduce the amount of water for patients with heart disease and kidney disease. (3) Intensive exercise is another effective preventive measure, and the implementation of ankle pump exercise is one of them. For some contraindications, such as extremely poor general condition and unstable condition;Ankle instability or ankle fracture that has not healed and has not been internally fixed;Older people with bone and joint tumors should avoid sports that can disrupt the healing process and cause new injuries, pain, or increased inflammation. (4) Smoking is a risk factor for venous thromboembolism, and smoking should be stopped. (5) Standing for a long time, sitting for a long time and poor sitting posture, wearing comfortable shoes and socks are also important ways to prevent venous thromboembolism. Overall, risk factors should be actively sought and controlled in older patients with acute venous thromboembolism. For older patients with no obvious cause, appropriate screening and prophylaxis should be tailored to the individual situation. Older patients with a family history or specific risk should be screened for thrombophilia. In terms of prophylaxis, appropriate methods should be selected according to the patient's risk level, such as health education, encouraging activities, mechanical prophylaxis, etc., and for high-risk patients, a combination of mechanical prophylaxis and pharmacological prophylaxis should be considered. (*From the Internet) high-quality author list