Liver diseases in the older adult.

Although there are no liver diseases specific to advanced age, the clinical course and management of liver disease in the older adult may differ from those in younger people. Changes in hepatic morphology with aging may lead to changes in liver function. Disturbances in laboratory liver function tests are similar as in younger people and should lead to the same vigilance in investigating for liver disease. Changes in immune function lead to more symptomatic acute hepatitis A, more progression to chronicity in hepatitis B and more fibrosis progression in chronic hepatitis C, especially after liver transplantation with livers from older donors. Treatment for chronic hepatitis C or autoimmune hepatitis is similar for younger or older adults, but side effects may be more prominent in older people. Comprehensive geriatric assessment should be part of the preliminary evaluation of the older patient with liver disease.