Liver disease can develop quietly, and the warning signs may be especially easy to miss in older adults.
Tiredness, poor appetite, swelling or confusion may look like ordinary problems that come with aging. In some people, noticeable symptoms do not appear until the liver has already suffered significant damage.
The liver is one of the body’s largest and busiest organs. It helps process nutrients from food, stores energy, removes harmful substances from the blood and makes substances needed for normal blood clotting. When the liver becomes damaged, many different parts of the body can therefore be affected.
Long-term liver damage can have several causes, including viral hepatitis, heavy alcohol use and a buildup of fat in the liver. Some medicines and other health conditions can also injure the liver. If damage continues for years, healthy liver tissue may gradually be replaced by scar tissue, a serious condition known as cirrhosis.
A review published in 2021 in the journal Hepatology discussed the special challenges of liver disease in older people. Symptoms may be vague and can overlap with other common health problems. This can make it harder for patients, families and even health professionals to recognize liver trouble early.
Fatigue is one possible warning sign. A person may feel unusually weak or exhausted even after getting enough rest. Because tiredness has many possible causes, including poor sleep, anemia, heart disease and medications, it cannot by itself show that someone has liver disease.
Loss of appetite and unexplained weight loss can also occur. Some people with advanced liver disease lose muscle and become physically weaker. In an older person, these changes may be mistaken for normal aging, but ongoing or unexplained changes deserve medical attention.
Jaundice is a more recognizable sign of liver trouble. It causes the skin or whites of the eyes to turn yellow because a substance called bilirubin builds up in the body. Dark urine, unusually pale stools and persistent itching can sometimes occur as well.
Swelling can provide another clue. Fluid may collect in the legs, ankles or abdomen when severe liver disease changes blood flow and affects the body’s ability to control fluid. Easy bruising or bleeding may also develop because a damaged liver may not make enough of the substances needed for blood to clot normally.
One of the most concerning symptoms is a sudden change in thinking or behavior. Severe liver disease can allow substances that would normally be removed by the liver to build up and affect the brain. This condition, called hepatic encephalopathy, can cause confusion, sleepiness, poor concentration, personality changes or forgetfulness.
In an older adult, these mental changes can sometimes be confused with dementia, medication side effects or other illnesses. However, new or rapidly worsening confusion should never simply be assumed to be part of aging. It can have many serious causes and needs prompt medical assessment.
Medicines are another important issue for older people. The liver helps break down many drugs, and aging can change how the body handles medicines. People who take several prescription and non-prescription products should make sure their doctor and pharmacist know everything they are using, including supplements.
Doctors do not diagnose liver disease from symptoms alone. Blood tests can look for signs of liver injury and measure how well the organ is working, while imaging tests can show changes in its structure. In some cases, additional tests are needed to identify the cause and determine how much damage has occurred.
Regular medical care can be particularly important for people with known risk factors, including diabetes, obesity, heavy alcohol use or previous hepatitis infection. Some forms of liver disease can improve when the cause is treated, while others can be slowed before severe damage develops. Earlier detection generally gives doctors more opportunities to protect the liver.
The main message is that liver disease does not always announce itself clearly in older adults. Persistent fatigue, unexplained weight loss, swelling, yellow skin or eyes, unusual bruising and changes in thinking should not be dismissed simply because someone is getting older.
Recognizing these changes and seeking medical advice can help uncover serious problems sooner.
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