Geriatric Gastroenterology: A Geriatrician’s Perspective

Aging trends in the United States and worldwide suggest an increasingly aging population, characterized by a longer life expectancy. Many live on to be nonagenarians, and some reach the stage of centenarians, with a few luckiest living to be supercentenarians. Older people are working longer, fulfilling societal demands. But alongside, they also manifest a significant decline in their functional status and cognitive function, along with a whole range of complex comorbid disorders. Frailty and care dependency are common in the old. Biological age poorly matches chronological age and deserves far more consideration. The ultimate goals while caring for older adults are to restore functional status where possible, understand risks and benefits of invasive and noninvasive management, adhere to the patient’s expressed wishes and advance directives, and keep quality of life foremost in mind. The chapter provides data on life expectancy and other demographics, comorbid disorders and functional limitations in aging people, lifestyles, and causes of mortality. Bearing in mind this background, specialists, including gastroenterologists, must adopt an approach that differs significantly from that used for younger individuals. Considerations must include life expectancy, comorbid and functional status, decision-making capacity, patient’s current wishes or prior expressed directives as part of advance care planning, and ethical aspects; some or all of them may factor in decision-making for a diagnostic procedure and medical and surgical management.