Practical considerations for colorectal cancer screening in older adults

Table 3 Colonoscopy-associated risks in older adults

Risk	Associated problems	Mitigation
Perforation	Bleed, infection, necrotic bowel	Endoscopic technique (carbon dioxide insufflation, use of pediatric endoscopic equipment, careful navigation of diverticular disease), adequate bowel preparation
Bleeding	Post-polypectomy bleed	Hemoclip placement for bleeding prevention when appropriate, diluted epinephrine injection, use of detachable snare, thermal coagulation
Cardiovascular event	Arrythmia	Medication review, screen for high-risk medications, confirm dosing appropriate for renal function; adjustment of anesthesia
Anticoagulation therapy interruption	Risk of thrombosis, MI, CVA	Liaise with prescribing physician; avoid colonoscopy during high-risk period; avoid interruption if possible
Delirium	Cognitive impairment	Risk assessment; optimize medication list, avoid holding medications with withdrawal potential on morning of procedure
Medication interaction	Polypharmacy increases sensitivity to anesthesia	Medication review; adjustment of anesthesia
Dehydration	Electrolyte disturbances	Appropriate counseling prior to colonoscopy prep; caretaker supervision to ensure patient safety during prep

MI: Myocardial infarction; CVA: Cerebrovascular accident.