Researchers based in Finland and the UK recently conducted a review of existing literature on celiac disease in later life. The article, published in Alimentary Pharmacology & Therapeutics, highlights how celiac disease can often be missed in the elderly population due to the dismissal of subtle celiac disease symptoms, such as fatigue, as being due to old age. With few studies published focusing on celiac disease in this population, Collin et al. set out to review the occurrence, presentation, diagnosis, and management of celiac disease in later life.
While celiac disease was previously thought to be a rare condition primarily affecting children and young adults, it is now known to be one of the most common genetic autoimmune diseases worldwide, and it can present at any age. Collin et al. report that about 25% of all celiac disease diagnoses are now made in persons aged 60 or above, and approximately 60% of cases in older adults remain undetected due to vague or non-classical symptoms obscuring the diagnosis. Another factor complicating diagnosis in later life is that elderly celiac disease patients are more likely to test negative on the celiac disease blood test and have lower levels of tissue transglutaminase antibodies (a diagnostic marker for celiac disease) even while consuming a normal diet with gluten. Because of this, physicians should not immediately rule out a possible diagnosis of celiac disease in elderly patients based on a negative blood test alone if there are enough other compelling signs or symptoms of the disease.
Some question whether it is meaningful to detect celiac disease in the elderly population, especially when the symptoms are mild, arguing that the adoption of a strict, gluten-free diet is a difficult lifestyle change. The researchers from this study, however, maintain that correctly diagnosing these patients is worthwhile, as the available evidence suggests a significant improvement in quality of life on a strict, gluten-free diet. Notably, this improvement in quality of life has been demonstrated even in seemingly asymptomatic elderly patients.
Beyond improvements in quality of life, the study authors emphasize the importance of achieving the proper diagnosis and implementing treatment to improve overall health and potentially prevent severe complications, such as enteropathy-associated T-cell lymphoma and low-energy bone fractures. While the healing of damaged villi may be slower in elderly patients when compared to younger patients, recovery is still expected to be good with adherence to a strict diet. Collin et al. report the findings from one study by Hankey and Holmes which found strict compliance with the gluten-free diet in 90% of their elderly celiac disease patients. These results demonstrate that while making such a large lifestyle change later in life can be difficult, it is certainly possible for patients who are motivated to improve their health and quality of life.
Importantly, the study authors conclude the level of suspicion of celiac disease should be as high in older patients as it is in younger patients. This, paired with screening at-risk groups – such as those with other autoimmune diseases or a family history of celiac disease – should help increase the rate of detection of celiac disease in elderly patients so they may benefit from the gluten-free diet.
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Are you looking for resources to help navigate celiac disease and the gluten-free diet in later life? Check out the Celiac Disease Foundation 7-Day Senior Gluten-Free Meal Plan and the Healthcare Facility Brochure!