Liver Disease in the Elderly

This chapter addresses the unique aspects of hepatic physiology and liver diseases in older adults. Aging is associated with reduced metabolic and regenerative capacity of the liver, and the clinical presentation and prognosis of many liver disorders can be different in older adults compared with younger persons. In particular, drug-induced liver injury and acute liver failure have a worse prognosis in the elderly. Older patients often have endured decades of the metabolic syndrome, and nonalcoholic steatohepatitis-related cirrhosis is increasingly observed with advancing age. Because longer duration of cirrhosis is associated with a greater risk of hepatocellular carcinoma, this tumor and other malignancies of the biliary tract are more common in elderly patients. Liver transplantation should be considered in selected older candidates guided by their physiologic status rather than by their chronologic age.