Nonalcoholic fatty liver disease (NAFLD) is commonly found disease in the geriatric population. it presents its more sever forms in this age group with hepatic diseases like, nonalcoholic steatohepatitis, cirrhosis and hepatocellular carcinoma and extra-hepatic manifestations and complications such as cardiovascular disease, extrahepatic neoplasms. Therefore, prompt diagnosis and management of this condition poses a major challenge for healthcare professionals.

Pharmacological treatment is an alternative or adjunctive approach to lifestyle treatment. However, current guidelines recommends no therapeutic intervention for elderly more than 65 years. Increased age and NAFLD may accelerates the risk of adverse drug reactions including drug-induced liver injury. Therefore, the choice of treatment must be cautiously made which can balance the benefits and risks in terms of adverse events and pharmacological interactions.

The proper treatment strategy for elderly patients require a multidisciplinary approach. Non-pharmacological treatment such as diet and physical exercise has to be given in customized manner, in view of individual physical limitations of elderly people and the need for an adequate caloric supply.

Moreover, in elderly, early diagnosis of cirrhosis and its further management is crucial to avoid the risk of complications. Nevertheless, diagnostic investigations or treatment options for elderly and the young are comparable except that liver transplantation is a rare procedure performed in the younger age group. Although fibrosis progression in elderly patients is also diagnosed and examined through non-invasive techniques, liver biopsy might be performed in selected elderly patients. 

Source: Bertolotti M, Lonardo A, Mussi C, et al. World J Gastroenterol. 2014;20(39):14185-14204.