Colonoscopies in the Elderly: Guidelines, Risks, and Alternatives

Doctors with the U.S. Preventive Services Task Force recommend that adults aged 50 to 75 have a colonoscopy screening, even without symptoms. Colonoscopies in people age 76 to 85 should be limited to a case-by-case basis due to higher risks associated with this procedure in the elderly. This age group should consider alternatives to colonoscopy, like stool sample tests and CT colonography.^[01]

The following are the guidelines for the frequency with which these screenings should be performed:^[01]

• A colonoscopy should be performed every ten years.
• CT colonography should be performed every 5 years.
• Stool sample tests should be performed every year.

The guidelines for preparing for a colonoscopy vary between individuals, but all colonoscopy preparations involve a bowel prep kit. The bowel prep kits include laxative and electrolyte formulas used to clear the colon completely of stool before the colonoscopy. The typical laxative formula doctors prescribe in a bowel prep kit will be either a polymer-based formula (PEG) or a saline-based formula (NaP). Of those two formulas, doctors recommend that seniors or individuals with certain conditions use the PEG bowel prep kit due to its reduced risk of disturbing electrolyte balances.^[02,03]

Aside from the bowel prep kit, there are several other steps doctors recommend seniors should do to prepare for a colonoscopy:^[02,04]

• Eat a low-fiber diet starting a few days before a colonoscopy.
• On the last day before a colonoscopy, stick to a clear liquid diet with plenty of electrolytes.
• Keep track of bowel movements to make sure movements are clear before the procedure.
• Don’t ingest any dyes like food coloring ingredients that might be mistaken for blood during the colonoscopy.
• Inform the doctor ahead of time of any medications or supplements that may interact with the bowel prep kit ingredients.
• Use underwear protection if accidents are a concern.

Make sure to contact the doctor if colonoscopy prep is not going as expected, like in the following cases: ^[02]

• Forgetting to begin the bowel prep kit on time
• Feeling ill
• Not having bowel movements as expected from the bowel prep kit
• Having severe abdominal pain
• Vomiting or an inability to keep liquids down
• Being unable to finish or stick to the schedule of the bowel prep kit

In most age groups, colonoscopies are generally considered safe, but there are risks when performed on seniors aged 76+. According to recent studies, seniors are more prone to post-colonoscopy complications due to their underlying conditions (comorbidities) and sensitivities.^[05]

Complications can be caused by any or all of the following stages of the procedure:^[06]

• Side effects from laxatives during bowel prep
• Side effects, like cardiovascular events, from the sedation medication used during the procedure
• Damage to tissue caused by the camera during the procedure

Keep in mind that seniors with comorbidities like chronic constipation, kidney disease, diabetes, a high body mass index (or BMI), and those who use narcotics or antidepressants are more at risk from complications from colonoscopies. Close case management from a senior’s doctor is important to avoid complications with colonoscopies both in the short and long term.^[02]

Let our care assessment guide you

One often-recommended alternative to colonoscopy is a fecal immunochemical test or a FIT, which tests for blood in a stool sample. This is recommended for people without a personal or family history of colon cancer. If this test runs positive for blood, a colonoscopy is then recommended.

This test can be sent to you at home, where you would provide a stool sample then send the test back through the mail in a specialized, pre-paid mailer. This test can identify blood in the stool to see if a follow-up screening is necessary. There is also a DNA test that can be performed alongside the FIT test, using the same stool sample. This DNA screening tests the sample for alterations in DNA or mutations that might signal cancer or disease.^[07,08]

The stool test is not the only alternative screening available, though it’s the only alternative that doesn’t require bowel prep. Thanks to new computer programs, a non-invasive virtual colonoscopy is now possible. After the bowels are cleared with bowel prep, the doctor takes a CT scan of your intestines, runs it through the computer, and a 3D image of your colon is produced. Though bowel prep has risks for the elderly due to electrolyte disruption, it’s less strenuous to recover from than sedatives or bowel perforation.^[07]

This form of CT screening is seen as less risky to seniors than traditional colonoscopies using sedatives and cameras.^[09]

Luckily, medical technologies are evolving to offer alternatives to colonoscopies and their risks. Many health insurance providers cover these alternatives due to their effective screening abilities and safety. Be sure to advocate for yourself or your loved one if you’re concerned about any pre-existing health conditions that might adversely affect the test prep or test results.