Colonoscopy for an 85 year old?

[Tensmumym]

My 85 year old mum has been anaemic for at least a couple of months. A stool specimen has just revealed that there was blood in her stool. The GP has said that the next step would be a referral to a bowel specialist and that she should be seen within 2 weeks. My mum has a probable diagnosis of Alzheimer's and moved into a care home a few months ago. She is very early stages and the main way she has been affected wrt to the dementia is through loss of language -though she knows what she wants to say and can usually eventually convey her meaning - but it is of course very frustrating for her. She is naturally pessimistic and I don't think would want treatment if it is cancer which she has had 3 times before. We are due to see the GP together on Tuesday. I spoke to the GP today and she said we need to decide if we want any investigations at all as there may not be a point in putting her through any trauma involved if we're not going to do much anyway. She has become more frail but can still walk unaided and dress herself etc so I think would be okay for a colonoscopy. Does anyone have experience of an elderly relative having a colonoscopy? Thanks.

[BarbarianMum]

Not exactly, but I have had many (Crohns) and have met several elderly people having likewise.

In general the colonoscopy itself is not too bad - many people choose sedation to help them get through it (personally I've never chosen this and been fine). What can be more tricky is the fasting and cleansing of the bowel that comes first. This can be both exhausting and demeaning if you can't get to a toilet in time (within a few seconds) so your mum will need assistance with this. All the elderly people I have methavedone this bit in hospital for that reason.

HTH

[Kundry]

A bigger question is would she be OK for what comes after a colonscopy. TBH she sounds fairly OK for a colonoscopy but very high risk for surgery.

Being seen by the specialist and discussing options there sounds a good idea - they can assess what they think she is well enough for and you and your mum can decide how much she wants to know or would want treated.

[Tensmumym]

Thanks very much Barbarian and Kundry.

[MarthaCostello]

Agree, the bowel prep is exhausting. It would probably be much harder on someone frailer. Some people find colonoscopies really painful, others breeze through. My sedation failed, but I didn't have any pain. The sedation might also be an issue with her Alzheimer's? I had a more successful sedation for a subsequent procedure and I felt very out of it afterwards, drifting in and out of sleep, and not remembering things properly.

I had bowel cancer treatment two years ago and it knocked me sideways and I was an otherwise heathy 21 year old. Some of the patients I met were nearer your mum's age, but none quite as old, and actually all fared much better than me. But I think someone that bit older would really struggle. And with bowel cancer, unlike some others, the surgery also affects bodily functions. Usually for colorectal cancer, they would remove a section of colon containing the tumour, and they would usually need to create a temporary or permanent colostomy (or possibly an ileostomy, depending on location of tumour). These can be distressing, and may cause difficulties if your mum starts to struggle with her memory in the future. They require daily care and the correct application of various parts, as well as having to empty it. As well as the technical issues, the side effects from the digestive alterations can be exhausting. Then the chemo side effects add to that.

That's all a bit negative, sorry. Lots of people do get through the treatment without any hiccups, so it's not guaranteed that she would have all these issues.

I'm so sorry that your mum is going through this, especially after her previous cancers I hope you are able to reach a decision you feel comfortable with and that the GP is able to help

[Tensmumym]

Thank you very much for your reply Martha. So sorry to hear that you have been through this cancer treatment at such a young age. I hope you're okay now.

[LIZS]

I would think the main risk is that she will get an obstruction and become acutely ill. At this age cancers tend to be slow growing. DM has been through Bowel cancer twice , 2 ops to remove plus intensive chemo/radio. For her the preparation the day before was the nastier part, plus by then she felt pretty unwell anyway. She didn't need a colonoscopy second time, it was a scan and op. They can remove some polyps and lesions via colonoscopy but whether they subsequently need to operate and remove more tissue depends on the nature and extent of any tumour.

[Tensmumym]

Thanks very much LIZS.

[iwantgin]

FIL is 82 - and has just been through this.

Unfortunately for him the outcome is poor and inoperable.

But he managed the pre-colonoscopy fasting with a lot of clear, precise instruction from us.

[Tensmumym]

Thanks for posting iwantgin. Sorry to hear that it's a poor outcome.

[MarthaCostello]

Tensmumym I'm fine now thank you :) apologies, I wasn't trying to make it about me, just thought it might be a useful comparison as treatment is difficult for young, "healthy" people so perhaps harder for those weaker and frailer (although they will adjust treatment, they will try to take into account what each person can cope with).

Are you and the doctor deciding about this, or will your mum be involved in the decision?

If you want more information about bowel cancer, the Macmillan website is very good. Try not to Google, only use NHS and "official" websites, as so much of the information on the internet is out of date or suggesting wacky treatments.

[MarthaCostello]

iwantgin sorry about your FIL's diagnosis.

[Tensmumym]

Thanks again Martha. I remember when my mum was first diagnosed with breast cancer she was 77. She had chemo, surgery and radio and pretty much breezed through all of it. She only got sick once with chemo and it seemed as though younger people suffered more with the chemo than older people. My mum will be involved with the decision but will probably look to be guided by my sister and I. I need to tell her today about the stool specimen being positive to prepare her for tomorrow.

[MarthaCostello]

I hope she wasn't too panicked about the result Tens and that today's appointment went OK.

It's odd with chemo. Children seem to be able to take much more aggressive regimes than adults, but younger adults tend to have worse side effects than older ones (my oncologist said this was due to the rate of cell reproduction being higher, so more cells would be killed off), but then the elderly are less likely to be able to tolerate the treatment as they are often much frailer.

I'm glad your mum's previous treatment went well, but it's terribly unfair that she is facing a second cancer diagnosis.

I really hope there's another explanation for the blood and that if not there is a treatment path that is acceptable to your mum.

All the best