From the Guidelines
For a 70-year-old individual undergoing colonoscopy for routine colorectal cancer screening, it is crucial to prioritize a thorough pre-procedure assessment, modified bowel preparation, careful sedation, and post-procedure monitoring to minimize risks and optimize outcomes, as supported by the most recent guidelines 1.
Key Considerations
- A thorough pre-procedure assessment of cardiovascular and pulmonary status, medication review, and evaluation of cognitive function is essential to identify potential risks and comorbidities that may impact the screening process.
- The bowel preparation may need modification with lower-volume options like split-dose preparations of polyethylene glycol (PEG) solutions or sodium picosulfate to improve tolerability, as recommended by recent studies 1.
- Adequate hydration is crucial during preparation, with clear liquids recommended to prevent electrolyte imbalances and dehydration.
- Sedation should be carefully titrated, typically using reduced doses of medications like midazolam (1-2mg) and fentanyl (25-50mcg) or propofol under monitored anesthesia care, to minimize the risk of complications.
Procedure and Post-Procedure Care
- The procedure itself carries slightly higher risks of complications such as perforation or cardiovascular events in older adults, emphasizing the need for careful monitoring and management.
- Post-procedure, older patients may require longer recovery time and should have someone accompany them home to ensure safety and provide support.
- Despite these considerations, colonoscopy remains beneficial for healthy 70-year-olds with a life expectancy of at least 10 years, though screening can generally be discontinued after age 75 unless the patient has specific risk factors or symptoms, as suggested by the USPSTF guidelines 1.
Decision-Making and Risk-Benefit Assessment
- A discussion about the risks and benefits should occur before proceeding with screening in this age group, taking into account individual factors such as comorbidities, life expectancy, and prior screening history, as emphasized by the AGA clinical practice update 1.
- The decision to continue CRC screening in individuals older than 75 years should be individualized, based on an assessment of risks, benefits, screening history, and comorbidities, with consideration of the latest evidence and guidelines 1.
From the Research
Special Considerations for a 70-year-old Individual Undergoing Colonoscopy
- The decision to screen for colorectal cancer in adults aged 76 to 85 years should be an individual one, taking into account the patient's overall health and prior screening history 2
- Screening colonoscopy may have a modest benefit in preventing colorectal cancer in beneficiaries aged 70 to 74 years and a smaller benefit in older beneficiaries 3
- The risk for adverse events is low but greater among older persons, with an excess 30-day risk for any adverse event in the colonoscopy group of 5.6 events per 1000 individuals in the 70- to 74-year age group and 10.3 per 1000 in the 75- to 79-year age group 3
Factors to Consider
- Age is a risk factor for colorectal cancer, but older adults with a history of prior screening are at lower risk for CRC compared to those who have never been screened 4
- Decision-making for CRC screening and post-polypectomy surveillance colonoscopy in older adults is complex and several factors including age, screening history, comorbidities, functional status, bowel preparation, prior experiences, preferences, and barriers need to be considered when weighing risks and benefits 4
- The incidence of advanced polyps increases with patient age, and recommendations for future colonoscopy decrease with age 5
Clinical Findings and Recommendations
- The finding of colorectal cancer is rare, with the highest incidence among diagnostic examinations 5
- The incidence of advanced polyps increases with patient age from 65-69 to ≥85 years for screening and surveillance 5
- Recommendations for future colonoscopy vary by findings at current colonoscopy and decrease with age 5