S536 Bowel Preparation Quality in Elderly vs Younger Adults: Implications for Colorectal Cancer Screening

Introduction: The gold standard modality for colorectal cancer (CRC) screening is colonoscopy, but its accuracy is highly dependent on bowel preparation. Elderly patients demonstrate significant bowel preparation nonadherence due to cognitive impairment, comorbidities and reduced physical function. Our study highlights the adequacy of current bowel preparation regimens for older adults and identifies key areas of alterations that could result in better compliance and enhanced clinical outcomes. Methods: Our literature search yielded 5 studies published between 2016 and 2024 from PUBMED. Studies chosen included prospective cohorts, observational studies and case reports. All studies involved patients aged 60 and older undergoing elective colonoscopy. We extracted information on the bowel preparation: type and volume, dosing strategy (split vs single), use of adjuncts (prokinetics, simethicone), education methods, subjects tolerability, safety profile, adenoma detection rates, and the study's prep adequacy measures (using Boston Bowel Preparation Scale). Studies that did not report stratified data, involved emergency colonoscopy, or were in language other than English were excluded. Results: Among 3,436 elderly patients, bowel prep adequacy ranged from 65.4% to 81.1% and was significantly lower than younger cohorts (77.3%-94.4%). Common risk factors for poor prep included: male sex, type 2 diabetes, constipation, impaired mobility and lack of support. Mean BBPS scores were lower in the elderly patients: 6.3 vs 6.6. PEG-based split-dose regimens, especially when combined with counseling, improved bowel preparation quality and compliance. Adjunctive agents like simethicone and prucalopride also enhanced mucosal visibility. Conclusion: Physiological and logistical limitations restrict many elderly adults from achieving the necessary bowel preparation for colonoscopy. Administration of a simplified, split-dose polyethylene glycol regimen that is accompanied by targeted education can significantly improve the success rate of this preparation among elder adults. A regimen that incorporates hydration monitoring, an assessment of the patient's unique bowel habits to tailor preparation instruction, and a simplified instruction set makes for a patient-centered approach, leading to better bowel preparation and decreasing the need to cancel colonoscopies.