An article published in Age and Ageing discussed that the prevalence of chronic liver disease is increasing in the elderly population. These diseases mostly have asymptomatic or non-specific presentation, and may easily go undiagnosed. 

The authors reported that abnormal liver function tests of unknown cause are a common reason for referral to secondary care. Thus, investigating the older person with abnormal liver function is important. In fact, in patients presenting with mild abnormalities, the same vigilance should be applied to an older person, as in a young person. 

Liver biopsy is safe but often overlooked in this age group and may provide useful information to diagnose, direct therapy and prognosticate. Treatment options are similar for all age groups, with a few subtle differences, although further evidence is frequently required for the older population. Morbidity and age-adjusted mortality are often more severe in older individuals, and therefore, early diagnosis and intervention is important.

It is important that geriatricians recognize that the prevalence of liver disease is increasing in older age groups, including rarer liver diseases. Awareness of vague symptoms and signs which could indicate liver abnormalities and interpretation of investigations such as LFTs is vital. Furthermore, in cases with diagnostic uncertainty, liver biopsy is safe, and may lead to appropriate treatment. Special attention should be paid to those who are prescribed diuretics, lactulose and benzodiazepines as adverse effects are more common in the elderly. 

This article summarized that the science behind the ageing liver would suggest that it is less able to cope with insults and may contribute to more severe disease or decompensate existing disease

Source: Age and Ageing. Volume 38, Issue 1, January 2009, Pages 11–18, https://doi.org/10.1093/ageing/afn242