Diverticulitis is a common digestive condition involving the inflammation or infection of small, bulging pouches (diverticula) that can form in the lining of the large intestine, or colon. While often asymptomatic, inflamed diverticula can cause symptoms like abdominal pain, fever, and changes in bowel habits. This article explores diverticulitis in older adults, focusing on unique considerations, life-threatening complications, medical interventions, and long-term management.
Diverticulitis in Older Adults: Unique Considerations
The presence of diverticula, a condition known as diverticulosis, becomes more common with age. Over half of individuals over 60 and up to 75% of those over 80 may have these pouches. While diverticulosis often causes no problems, the risk of developing diverticulitis increases with age.
Older adults may experience diverticulitis differently. Symptoms can be less obvious or atypical, with pain less pronounced or fever absent even with infection. A weakened immune response with age makes older individuals more susceptible to severe infections and can alter their presentation of illness.
Existing health conditions, or comorbidities, further complicate diverticulitis in the elderly. Conditions like diabetes, heart disease, or kidney disease can increase complication risk and influence treatment. Managing multiple health issues often involves taking several medications, a practice known as polypharmacy, which can lead to drug interactions or side effects that might mask symptoms or affect treatment efficacy.
Complications That Can Be Life-Threatening
When diverticulitis progresses beyond simple inflammation, it can lead to severe complications that pose a significant risk, especially for older adults. Perforation, a tear in the bowel wall, allows intestinal contents to leak into the abdominal cavity, leading to peritonitis. This serious inflammation and infection of the abdominal lining is a medical emergency.
Abscess formation, a localized pocket of pus from infection, is another potential issue. If an abscess ruptures, it can spread infection throughout the abdomen, causing widespread peritonitis. Fistulas can also develop as abnormal connections between the colon and other organs, such as the bladder, allowing bacteria to spread and cause further infections.
Sepsis, a life-threatening condition where the body’s response to an infection damages its own tissues and organs, is a particularly dangerous complication of severe diverticulitis. Older adults are more vulnerable to sepsis due to weakened immune systems and comorbidities. These severe complications, if not promptly diagnosed and treated, significantly increase mortality risk in older adults.
Medical Interventions and Preventing Severe Outcomes
Medical professionals employ various strategies to manage diverticulitis and prevent the progression to life-threatening complications. Diagnosis typically involves a physical examination, blood tests for infection or inflammation, and imaging, most commonly a computed tomography (CT) scan. A CT scan is highly effective in confirming the diagnosis, assessing the extent of inflammation, and identifying any complications.
For uncomplicated diverticulitis, treatment often begins with bowel rest, a temporary liquid diet, and oral antibiotics to clear the infection. Pain management is also a component of initial care. Patients not improving or presenting with more severe symptoms, such as significant pain or signs of complications, usually require hospitalization for intravenous antibiotics and fluids.
Managing complicated diverticulitis, involving conditions like abscesses or perforations, may require more aggressive interventions. Larger abscesses might be drained percutaneously, a procedure guided by imaging. Surgical intervention, such as a bowel resection where the diseased part of the colon is removed, is reserved for severe cases, recurrent episodes, or when complications like uncontrolled infection, obstruction, or perforation threaten a patient’s life. In some instances, a temporary colostomy may be performed, diverting stool into an external bag to allow the colon to heal before a later reconnection.
Long-Term Management and Outlook for the Elderly
After an episode of diverticulitis, particularly for older adults, long-term management focuses on preventing recurrence and maintaining overall gut health. Dietary adjustments are often recommended, emphasizing a high-fiber intake from fruits, vegetables, and whole grains, along with adequate hydration. Regular physical activity also contributes to healthy bowel function and may help reduce the risk of future flare-ups.
Ongoing medical oversight is important. A follow-up colonoscopy may be recommended several weeks after symptoms resolve to assess the colon’s condition and rule out other issues. Adhering to these lifestyle modifications and attending follow-up appointments can significantly reduce the chances of repeat episodes of diverticulitis.
While diverticulitis can be serious, especially in older individuals prone to complications, most cases are manageable with timely and appropriate medical care. Fatal outcomes, though possible with severe, untreated complications, are relatively uncommon when individuals receive proper medical attention. With effective management strategies, older adults can typically achieve a positive long-term outlook following an episode of diverticulitis.