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Learning Objectives
Identify various common disorders of the large intestine that affect older adult individuals.
Understand the key differences in diagnosis and treatment for a variety of disorders of the large intestine between patients who are younger and those who are older.
Determine the most suitable evaluation and management plans for disorders of the large intestine that are frequently encountered in clinical practice.
Define optimal treatment for older adult patients with common disorders of the large intestine.
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Key Clinical Points
Endoscopic and radiologic testing for common disorders of the large intestine is safe; advanced age is not a contraindication to gastrointestinal endoscopic procedures, and indeed, such diagnostic testing is relatively high yield.
Symptoms ascribed to disorders of the large intestine may be manifestations of different diseases in older adults as compared to the young, and the high prevalence of comorbid illness and polypharmacy makes accurate diagnosis and effective treatment more challenging in older adults.
Disorders of the large intestine in older adults are a heterogeneous group of conditions, and include diverticular disease with its many manifestations, infectious and inflammatory colitides, bleeding, and ischemic disease. They are a major cause of morbidity and mortality in this age group. Appropriate and rapid diagnostic testing as well as personalized therapy is paramount to improve outcomes.
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In older adults, gastrointestinal (GI) disorders, especially those of the large intestine, account for a significant proportion of physician visits, inpatient hospitalizations, and health care expenditure in the United States. Not only are large intestinal disorders common, but in older adults their presentations, complications, and treatment may be different than in the young. This chapter focuses on diagnosis and treatment of a variety of diseases of the large intestine, including diverticular disease, Clostridium difficile–associated diarrhea, microscopic colitis, inflammatory bowel disease, colonic ischemia, colonic obstruction, and lower GI bleeding.
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Diagnosis of GI disorders in an older adult patient poses several challenges to the physician in addition to those present for all patients. First, comorbid illnesses are frequent and often numerous, and some such as dementia and depression, may impair adequate communication between patient and caregiver. Second, medications and their side effects may cloud the clinical picture; polypharmacy is common in older adults. Lastly, symptoms attributable to the large intestine may be manifestations of different diseases in older adults than they would be in the young. The astute physician must take these factors into consideration when treating all patients.
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Symptoms of digestive diseases may be misinterpreted or atypical in the aged. For example, constipation may be a symptom of irritable bowel syndrome in a young patient, whereas it might herald an obstructing lesion in an older patient. Rectal bleeding in a young person is most commonly from hemorrhoids or inflammatory bowel disease. In older adults, diverticulosis, ischemic colitis or colon cancer more commonly cause rectal bleeding. A complete and thorough ...