Screening Colonoscopy in Very Elderly Patients

Abstract

Current guidelines for colorectal cancer (CRC) screening do not specify an age limit above which screening is not recommended. The number of screening colonoscopies in elderly US patients has increased dramatically since Medicare coverage was approved in 2001.¹ However, some clinicians may have concerns with regard to screening extremely elderly patients, especially when an invasive modality such as colonoscopy is used. Colonoscopy in very elderly patients is associated with lower procedural completion rates, higher complication rates, and higher risk of inadequate bowel preparation.^2-6 Other theoretical concerns yet to be rigorously evaluated include a potentially higher incidence of logistical problems (eg, transportation) and higher probability of informed consent difficulties because of cognitive impairment. In addition, very elderly patients have shorter life expectancies, potentially limiting the benefits of screening procedures. The objective of this study is to estimate the mean extension in life expectancy in very elderly vs younger patients using cross-sectional data collected from patients undergoing screening colonoscopy.