Gut Health Issues in the Elderly

Age-related problems of the gut are common in the elderly. There is no need to worry, if caregivers are watchful of early symptoms

The gastro-intestinal tract [gut], the organ that accepts nourishing food, digests, absorbs and assimilates, is no exception to the rule of nature: aging.

All the same, the vast reserves of the gut ensure that the system does not “fail” in providing essential supply of nutrients. However, any noticeable, or obvious, complaint of the gastro-intestinal tract in the elderly warrants adequate attention.

Age-related changes occur throughout the gut. The number and sensitivity of the taste buds, for instance, decline with age, impairing the ability to identify food by taste. Loss of teeth, weakening of muscles necessary for chewing, and a modest decrease in saliva production can all add up to difficulties in eating. As a result, our elders may sometimes lose interest in food, lose weight, and develop nutritional deficiencies.

Certain neuromuscular problems can also impair swallowing as people age. Weakening of the muscles of the oesophagus [the food pipe] makes it difficult for food to move down. Food may also regurgitate back into the mouth. In addition to this, the reflux of acid from the stomach back into the food pipe is often a problem in the elderly, due to decline in oesophageal function and reduced oesophageal muscle action.

Acid decline

Acid secretion from the stomach declines with age, although it may not affect digestion. In some people, it may result in deficiency of vitamin B12, excessive bacterial growth in the small intestine, reduced absorption and poor digestion. Aging also leads to a modest slowing of stomach muscle function, resulting in an early sense of filling and decreased food intake.

The small and large intestines withstand aging better. There are no major changes in small intestinal motility, transit time, permeability, or absorption. Although aging does not cause major changes in the motility of large intestine and rectum, a reduced perception of muscle distention together with a modest delay in transit time may play a role in constipation, which is quite common in the elderly.

It is important to note that any significant and persistent complaint relating to your bowel habits should be evaluated. It should not be just attributed to aging.

Certain symptoms and signs should, of course, raise an alarm.

Difficulty in swallowing, with a perception of food getting “stuck” midway in the food pipe, or the need to sip some water to “push the food down” may suggest a growth in the oesophagus.

Go for a check-up

Vomiting in the elderly should always indicate a detailed evaluation, particularly if it happens in the evening, and the vomit contains food that was eaten all through the day. Blood in the vomit or stools, or passage of dark, tar-like stools should also prompt an immediate visit to the doctor. A recent onset of loose motion or constipation, sometimes alternating, and passage of mucous in the stools may also be a signal for check-up.

While pain in the abdomen is not common in the elderly, such a complaint, particularly related to the intake of a meal, may indicate a significant problem. Yellowish discolouration of skin and eyes, sometimes associated with itching all over the body, may also be suggestive of obstruction.

In addition, unexplained loss of appetite or significant loss of weight should always be evaluated. More often, it is the close relatives who would notice such changes rather than the elderly patient.

Taking care of the gut

Evaluation of gut-related disorders in the elderly may involve endoscopic examination of the upper or lower gastro-intestinal tract, ultrasound, or CT scan-imaging of the abdomen, or other special investigations, in addition to routine tests with blood, urine and stools.

It may also be mentioned that poor dental condition could hamper chewing; the elderly should, therefore, be provided with easy-to-eat foods. Adequate intake of fibre and water must be ensured and vitamin and mineral supplements prescribed for those who have manifestations of malnutrition.

The elderly are often prescribed multiple drugs for various problems, particularly pain-killers for joint pains, drugs for diabetes or high blood pressure etc., Many of these drugs cause oesophageal and stomach irritation, even resulting in ulcers that bleed. Therefore, any complaint that occurs after initiating a drug should be reported to the doctor.

Many problems of the digestive tract in the elderly may remain dormant or cause non-specific complaints. Early recognition of problems before they become severe would be of great help in providing timely and effective treatment.

It is imperative that caregivers should always be alert to subtle symptoms in the elderly, before they develop into full-blown affections. After all, it is the gut that maintains our nutrition and, therefore, wellbeing.

Stress in the Elderly

We all need to face different kinds of mental stress in various stages of life. Chronic and excessive stress is harmful and can cause physical or mental problems. Therefore, we should all understand more about stress and learn appropriate coping strategies for our wellbeing.

Sources of stress

  • Changes of lifestyle and financial status after retirement
  • Caring for grandchildren
  • Caring for a sick spouse
  • Death of relatives, beloved or close friends
  • Deterioration of physical abilities and chronic illness
  • Worries for not being able to live independently
  • Worries of institutionalisation.

Stress management

  • The elderly can share their difficulties and feelings in facing stress, and way of coping, with those they can confide [e.g. relatives and friends]. This helps to ventilate emotions and facilitate the learning of different strategies for coping with stress
  • An active social life, healthy lifestyle and relaxation techniques are all useful ways to handle stress
  • Engaging in volunteer work is a means to help those who are less fortunate. It also helps to boost self-confidence and broaden one’s outlook in life
  • Positive thinking, such as appreciating one’s achievements and strengths, can help to enhance self-confidence and cope with stress
  • Smoking, drinking and substance abuse are harmful and should never be used as ways to cope with stress.

Team CW

Srinivas Bevinje
Dr Srinivas Kakkilaya Bevinje, MD, is a Mangalore-based consultant physician. His areas of interest include metabolic medicine, infectious diseases, and community health.


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