Colonoscopy Risks to the Elderly

Written by christine lebednik
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Since the traditional designation of ‘elderly’ has been set at age 65, and since the colonoscopy protocol guidelines indicate first colonoscopy testing at either age 50 or 55 and thereafter at 10-year intervals, most colonoscopies are done on individuals who in some sense quality as “elderly.” Therefore, the risks of colonoscopy for the elderly is considered first in terms of the risks pertinent to colonoscopy patients of any age and then as to whether or not those risks increase with age or if new risks can also be attributed to age. Inadequate available information on risks and biased communication between physicians and patients present their own risks with the colonoscopy protocol. There are also multiple risks that can result at any age from colonoscopy at three stages: during the pretest preparation, during the colonoscopy itself and post-protocol adverse events. Some, if not all, of these risks at least potentially increase with age.

Colonoscopy Risks: Inadequate Communication and Information

In the article “Risks and Benefits of Colonoscopy for Elderly Ppatients” the authors note that there isn’t “a lot of data that would support good answers” to questions regarding colonoscopy risks in reference to the elderly. One of the primary overall risks of colonoscopy in fact is precisely this absence of data.

Indeed, because of their view that colonoscopy is a supremely important screening test some practitioners refuse to entertain any recognition of the risks of the test. Yet, for some patients, even those who are not elderly, the risks may outweigh the benefits.

This kind of inadequate information and communication between physician and patient is a risk in and of itself in that it makes it difficult for a patient to make an informed choice of the benefit/risk trade-off of the protocol.

Risks of Colonoscopy: General

The risks of colonoscopy itself include bleeding (potentially heavily), perforation of the intestine and adverse reactions to the required medications used in the procedure.

Also, adverse reactions to the solutions used during the pre-protocol preparation phase can occur. Some patients can have serious reactions in the preparation phase, such as becoming weak and faint as a result of the combination of fasting, the solutions consumed and the bowel cleansing itself.

Colonoscopy as an Invasive Procedure

While the risks of colonoscopy may seem small in comparison to the importance of early detection of colon cancer, as an invasive procedure, colonoscopy can result in death. Though it is a very rare occurrence (less than 1 per cent of patients undergoing the protocol), people do die during colonoscopies, or subsequent to them as a direct result of the colonoscopy. This is particularly true in instances involving perforation of the intestine, but in individuals with a tendency to medication sensitivities, death can result from adverse reactions to the medications and intestine-cleansing agents.

You should weigh benefits versus risks of any protocol with at least two circumstances in which the protocol itself potentially can result in death. Since in most instances it is only in the context of an invasive procedure that sedative/general anaesthesia medications are given, both the colonoscopy elements that carry a risk of causing death are associated with the protocol’s status as an invasive procedure. Personal medical history may impact one’s prognosis with regard to likelihood of experiencing one or more of these risks.

Age-Related Increase in Risk Factors

Information available on whether colonoscopy risks increase with age diverges wildly. Some experts say the risks remain the same, others that they increase slightly as an individual ages, and others say that risks for those 70 and older experiencing serious gastrointestinal events are “significantly elevated.” Specifically, some experts indicate that the risks of gastrointestinal bleeding or perforation increase between the ages of 80 to 84 by as much as 75 per cent over individuals under the age of 70. Some experts also suggest that risks of adverse reactions to the bowel cleansing solutions also increase for patients above a certain age, ranging anywhere from age 70 to age 85.

Post-Colonoscopy Events: A Particular Concern for the Elderly

A significant concern with reference to colonoscopy risks in the elderly is that some evidence suggests a definite increase in the risk of post-colonoscopy adverse events. Some researchers found that while in younger patients gastrointestinal adverse effects, including intestinal puncture, generally occurred during or immediately after the colonoscopy, in older colonoscopy patients such adverse events could occur as much as 30 days after the procedure.

Current Trends

While there is considerable lack of agreement among experts on the topic, there is a trend toward reconsidering the value of the colonoscopy protocol for older patients given the potential increase in the risks of the protocol. The U.S. Preventive Task Services Task Force has recommended against colonoscopies for those over 85. Other experts have suggested that the benefits of screening decrease with increasing age while the risks increase, and have suggested a cut-off age of 75 for this protocol.

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