Elderly patients have a high tolerance for gastroesophageal reflux disease symptoms, putting them at risk of untreated severe illness, says Andy Kistler, M.D., PharmD. 

GERD is more common with age, with a 20% prevalence or higher, according to Kistler, a gastroenterologist. And though elderly patients may not complain of severe symptoms, an endoscopy may reveal significant damage to the esophagus, he explains.

Elderly patients are also more likely to experience atypical GERD symptoms. These include chest pain, dysphagia, respiratory challenges (hoarseness, cough, wheezing), nausea, and vomiting. In addition, GERD symptoms in older adults may indicate an underlying cardiopulmonary issue that warrants prompt evaluation for additional medical care, Kistler adds.

The first step in GERD management is counseling on lifestyle modifications, Kistler advises. These include avoiding trigger foods, not eating three hours before bedtime and elevating the head of the bed. Elderly patients without alarm symptoms such as unintentional weight loss, anemia, and persistent vomiting can also be given a trial of a proton pump inhibitor. But PPI indication and dosage should be reassessed regularly, he adds.

Dr. Kistler’s recent article on the care of elderly patients with GERD can be found at Gastroenterology Advisor. His writings appear in a number of McKnight’s Long-Term Care News’ clinical sister publications.