Colonoscopy in the Elderly. How Old is too Old?

I am frequently asked what is the upper age limit for offering screening colonoscopy.  Patients today are often more informed on certain medical issues than their doctors are.  I support their empowerment.  Of course, we physicians, as actual medical professionals, presumably have more credibility in opining on the practice of medicine.  In my own life, I always give great weight to the folks I hire, whether they are tradesmen or professionals.  Why would I not give consideration and deference to one who has years of training and experience?  If I needed an attorney to litigate an issue, would I presume to advise on the optimal trial strategy?  ‘He who represents himself has a fool for a client.’

Patients can acquire a great deal of medical knowledge, but they are not as easily able to exercise sound medical judgment.  This takes us professionals years to develop.  Consider this weighty maxim:  It takes 10 years to acquire 10 years of experience.   Indeed, I am still trying to advance my skills after decades on the job.  As I have posted in this blog more than once, honed medical judgment is a seasoned physician’s strongest asset.  Consider the following 2 examples and decide which would be within a patient’s grasp to understand and which would be beyond reach. 

Research a drug to determine if the medicine might be responsible for a side effect.

Decide that a CAT scan of the abdomen is not necessary.

See the difference between knowledge and judgment?  One of the above tasks requires a professional and the other doesn’t.

So, how old is too old for a screening colonoscopy?  Although there are published guidelines addressing this, I do not have a firm cut off.  I think that the upper threshold must be individualized to the patient with consideration of their views and their medical status.   For example, a 65-year-old individual who is ‘due’ for a colon exam but is navigating through various medical struggles might not be an appropriate candidate for a routine screening exam.  But should an 80-year-old in great health who was last screened at age 70 be denied a screening test?

Elderly Woman Contemplates a Screening Colonoscopy.

Medical care is not simply following a checklist.  If it were, then you wouldn’t need a doctor.  You could just do it yourself as a DIY medical professional.   Instead of simply blindly following published colonoscopy guidelines (which often conflict with each other), kick the issue around with your doctor.   You can bring the knowledge but leave the judgment to the professionals.