Prevalence of chronic liver disease is increasing in the elderly. Onset is more insidious in older patients. Abnormal LFTs should be investigated thoroughly (unless inappropriate); liver biopsy is safe in the elderly. There are some subtle differences in treatment. Age-adjusted mortality is often greater in the elderly. It is important that geriatricians recognise 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. The same vigilance should be applied to older patients as it is to younger patients when interpreting abnormal LFTs, no matter how mild the abnormality. In diagnostic uncertainty, liver biopsy is safe, but often overlooked, 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. 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: James Frith, David Jones, Julia L. Newton, Chronic liver disease in an ageing population, Age and Ageing, Volume 38, Issue 1, January 2009, Pages 11–18