Colonoscopies and the Elderly, Is it Worth It?

Preventing disease and catching it early if it occurs is a cornerstone of health for people of all ages. Colonoscopies are an essential part of preventative health for colorectal cancer, as well as being a helpful diagnostic tool for other gastrointestinal conditions.

However, like most medical interventions, colonoscopies come with inherent risks, some of which represent a significant drawback for older adult populations in particular.

Sometimes, the risks of this uncomfortable and medically invasive procedure outweigh the benefits of gaining the information that can be collected during the colonoscopy.  For this reason, many medical practitioners in recent times have moved away from recommending routine colonoscopies for elderly patients.

In fact, some practitioners state that colonoscopies are inappropriate altogether on people over the age of 75. This is related to the fact that colon cancers grow relatively slowly, as well as older adults’ reduced overall lifespan.

If you are an older adult trying to figure out if a colonoscopy is appropriate for you, or if you are trying to help a family member or loved one make an educated decision about their medical care, we can help you understand the risks and benefits associated with having a colonoscopy.

What is a Colonoscopy, and Why Are They Done?

A colonoscopy is a medical procedure whereby a thin, flexible tube with a camera at the end of it is introduced into the colon via the anus. This allows the operator to visualize the inside of the bowel and look for any abnormalities that may occur.

The tube that is inserted can easily bend to move around the loops and twists of the bowel. It also blows air into the bowel to make it easier to visualize. If there are polyps, they can usually be removed at this time. If there is any other abnormal tissue, the doctor may also remove a small sample so it can be analyzed in the lab.

Colonoscopies are diagnostically useful because they allow your doctors to see the inside of your bowel, which is not possible otherwise. This lets them see if there are polyps, cancerous growths, or other pathological findings that could indicate you have an illness affecting the gastrointestinal tract.

Benefits of Colonoscopies in the Elderly

The long-standing recommendation has been for people over the age of 50 to have colonoscopies once every ten years if no polyps are found. They are recommended at an earlier age and a greater frequency for people who are genetically predisposed to colorectal cancer, who have a personal history of polyps, or who have a family history of the same.

Simply put, colonoscopies are beneficial because they are the single most effective tool for screening for colorectal cancer. The earlier colorectal cancer is caught, the higher the rate of survival and the less likely it is the cancer will have time to spread.

Colonoscopies are done for other reasons, too. If you are having unusual abdominal pain, diarrhea, or other concerning symptoms, your physician or gastroenterologist may recommend you have a colonoscopy, either to collect tissue for biopsy or to rule out and concerns related to the wall of the bowel.

Finally, colonoscopies are a useful way to excise a small amount of tissue from the bowel wall, either for biopsy or the removal of polyps. Doing these at the same time as a routine colonoscopy is far less invasive than the alternatives, such as a separate surgical procedure.

Drawbacks of Colonoscopies in the Elderly

Despite their benefits, colonoscopies come with a significant amount of risk as well. Unfortunately, many of these risks are exacerbated in the older adult population.

 

The possible risks associated with colonoscopies include the following:

• Bleeding or perforation of the bowel. Any time an object is introduced into the colon, there is a risk the bowel will be unintentionally perforated, which can have potentially fatal consequences such as sepsis.  This is very rare in elective cases (less than 1 in 1000).
• Complications associated with anesthesia. The drugs that are given to help you relax during the procedure come with their own set of risks, namely over-sedation and respiratory depression.

Ultimately, you will have to decide if these potential risks are worth the benefit of colon cancer screening.

Making the Decision to Have a Colonoscopy

The final decision of whether a colonoscopy is a good idea is usually made on a case-by-case basis in discussion with the patient, the physician or doctor, and other members of the patient’s family and care team.

It is essential the risks and benefits of the procedure are clearly understood so an informed decision can be made. Ultimately, the decision usually lies in the hands of the patient who may be undergoing the procedure.

No matter what you decide, it is important to bring your questions and concerns to the attention of your doctor or care team members. Because they know your specific health and physical circumstances, they can provide answers that are tailored to you.  In certain situations, other testing modalities may suffice. Ask your doctor about alternatives to colonoscopy.

Discuss Colon Cancer Screening with a Specialist

Talk to your doctor or a specialist about whether a colonoscopy is appropriate for you and be sure to share this article with any family members or friends who might be considering the appropriateness of a colonoscopy for their elderly parents or loved ones.