Management of Colonic Diverticular Disease in the Older Adult

While societal guidelines help direct management of diverticulitis and diverticular bleeding broadly, our review focuses on the latest data for nuanced care of older patients affected by these conditions.

Diverticulitis in older patients can present with non-specific symptoms so a broad work up is recommended. Once diagnosed, those with uncomplicated disease (Hinchey Class 0 or 1a) can be safely managed without antibiotics or admission depending on frailty and comorbidities. Most older patients with complicated diverticulitis (abscess, perforation or obstruction) should be hospitalized. Elective or emergent surgery for complicated disease (Hinchey Class 1b-4) is associated with higher morbidity and mortality, particularly in older patients. The risk of diverticular bleeding and re-bleeding significantly increases with age, potentially due to the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and anticoagulants. Diverticular disease and its associated complications disproportionately affect older adults. Management should focus on resuscitation, having low threshold for comprehensive work up and re-evaluating medication use for comorbid conditions to prevent recurrence.