Colonoscopy in the very old: why bother?

OBJECTIVES To evaluate the use of colonoscopy in patients aged at least 85 years. Does the ideal of an ageism free service apply? DESIGN A retrospective audit. SETTING Department of gastroenterology that carries out about 1000 colonoscopies annually in a district general hospital serving a population of about 320 000. SUBJECTS All patients aged at least 85 years who underwent colonoscopy over five years to 2003. MAIN OUTCOME MEASURES The indications for colonoscopy and its findings. The outcome of patients found to have colonic cancers. RESULTS Colonoscopy was completed in 219 cases (69%). The main reasons for failure were poor bowel preparation and severe diverticular disease. Normal findings occurred in 65 (30%) of the 219 cases that had had a complete examination. Colonoscopy identified a problem that explained the patient's symptoms in 116 (37%) cases. Polyps were found in 45 (14.2%) cases and malignancy in 28 (8.8%). CONCLUSIONS The absence of significant complications and comparatively high yield of colonic malignancies and polyps reinforces the value of colonoscopy as a diagnostic tool even after 85 years of age and despite the technical challenges of the procedure in this age group that limited completion. Increasing age alone should not preclude a patient from colonoscopy.