title: Investigating the frail elderly patient with lower bowel symptoms: what do we do now and can we improve?
abstract: OBJECTIVE
  To assess the utility of flexible sigmoidoscopy (FS) and minimal preparation CT (MPCT) in investigating lower gastrointestinal (LGI) symptoms in elderly patients who are too frail to undergo colonoscopy or spiral CT.
  
  
  METHODS
  All FS examinations performed in patients aged over 70 between 1 January and 31 December 2008 were analysed. Predictors of usefulness were determined using multivariable analysis. In patients who also underwent MPCT, we analyzed the correlation between FS and MPCT.
  
  
  RESULTS
  426 FS were performed. Bowel preparation was inadequate in 24% of procedures. Indications in which FS was useful were: radiological abnormality (odds ratio [OR] 9.32), history of polyps (OR 4.54) and rectal bleeding (OR 1.73). Indications for which FS was least useful were: change in bowel habit (OR 0.22), diarrhoea (OR 0.46) and constipation (OR 0.38).
  
  
  CONCLUSIONS
  LGI investigation in frail elderly patients can be rationalised according to indication. Performing FS and MPCT together is not always necessary.
authors.affiliation: Department of Gastroenterology and Hepatology, Imperial College London, Paddington. khaleel.jamil@nhs.net
authors.forename: K M
authors.initials: KM
authors.lastname: Jamil
authors.forename: J H
authors.initials: JH
authors.lastname: Jacomb-Hood
authors.forename: H M
authors.initials: HM
authors.lastname: Fidler
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000175:diagnosis*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D058996:Quality Improvement; D012189:Retrospective Studies; D012812:Sigmoidoscopy / Q000379:methods*; D036542:Tomography, Spiral Computed / Q000379:methods*