Colonoscopy for screening and surveillance in the elderly

    Research output: ThesisMaster's Thesis

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    Abstract

    [Truncated abstract] The Australian aging population presents an increasing challenge for health care providers to deliver health care in a constrained economic environment. All disciplines of medicine across medical and surgical specialties are being impacted by the growing population over the age of 75 yrs. The Australian health budget is not without limit and some areas of medical practice require periodic examination regarding the magnitude of benefit it is aiming to achieve. In Australia, colorectal cancer (CRC) is a major cause of morbidity and mortality and its incidence sharply rises with age. Screening for CRC and surveillance of adenomas has been demonstrated to reduce the incidence and mortality from CRC. Colonoscopy is the gold standard for the diagnosis of bowel pathology and the therapeutic removal of polyps. Colonoscopies however are costly, invasive and not without risk. Although colonoscopies are widely available in both the private and public sector, colonoscopy waiting times are considerably longer in the public sector, especially in tertiary hospitals. Public patients who are waiting longer for a colonoscopy may be impacted by the stage of colorectal cancer (CRC) at diagnosis. Thus the rationalisation of colonoscopy services is essential. The negligible benefit of continuing CRC screening, or adenoma surveillance in the elderly has been demonstrated in a few studies however the failure to account for co-existent illnesses have limited the interpretation of their findings. In this retrospective cohort study, the colonoscopy outcomes of 1474 patients who had an index colonoscopy during the period of 2002-2003, and satisfied the inclusion criteria, were compared to 950 healthy control subjects randomly selected from the electoral roll that did not have any hospital admissions or a colonoscopy during the 5 and 10 years preceding January 2002 respectively.
    Original languageEnglish
    QualificationMasters
    Publication statusUnpublished - 2012

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