Large intestine disease characteristics in older adults.
Constipation
(i) Affects 50% of elderly nursing home residents (ii) Caused by decreased mobility, cognitive impairment, co-morbidities and polypharmacy (iii) Not typically caused by decreased colon transition time (if any) (iv) Distinguished from IBS by the lack of abdominal pain and discomfort (v) Stool impaction is a significant complication
Diverticular disease
(i) Most common disease affecting large intestine in elderly (ii) Prevalence increases with age (iii) Prevalence 70% among elderly in the US (iv) Pathophysiology linked to age-related changes of intestinal microbiota and connective tissue of the colonic wall (v) Diverticulitis less likely to become complicated in elderly when compared with younger populations (vi) CCB and statins have protective effect
Irritable bowel syndrome
(i) Prevalence similar across age groups (ii) Elderly more likely to have an organic GI disease, hence, thorough work up recommended (iii) Rectal bleeding is common (iv) Chronic prostatitis can mimic IBS in older men
Clostridium difficile colitis
(i) Elderly are particularly vulnerable (ii) Most severe form of CDC disproportionally affects older nursing home residents (iii) Hospitalization, healthcare acquisition and the recurrence of CDC significantly higher in those above 65 years (iv) FMT failure rate more common in elderly (v) Elderly are not ideal stool donors due to age-related change in intestinal microbiota
Inflammatory bowel disease
(i) 15% of newly diagnosed patients are above 65 years (ii) Age-related immunosenescence and changes in intestinal microbiota predispose to development of IBD (iii) Older CD patients tend to present with isolated colonic inflammation and perianal fistula (iv) Rectal bleeding more common than diarrhea, weight loss and abdominal pain (v) Inflammatory phenotype predominates (vi) Disease less aggressive and progresses more slowly (vii) Mesalamine adherence is poor (40-60% of patients report nonadherence due to pills size, frequency of dosing and GI side effects) (viii) Side effects from immune-modifying agents not increased in elderly when compared to younger counterparts
