GERD in Older Adults

GERD in Seniors

Gastroesophageal reflux disease (GERD), also known as chronic reflux disease, is a common and severe medical condition in which acid in the patient’s stomach persistently travels up the esophagus. Over time, acid damages the soft tissue, leading to trouble eating, discomfort, pain, and potentially severe complications.

Stomach acid weakens with age, so symptoms are often less pronounced in elderly patients than in younger patients. As a result, GERD is often overlooked and causes significant harm before elderly patients begin treatment. Older adults and their caregivers need to monitor gastric symptoms and talk with their doctors about changes in their digestion and new or worsening discomfort.

What is GERD in Oder Adults?

The stomach is lined with a mucus membrane that protects it from the acids used to break down food and ready it for digestion. While the acid is strong enough to dissolve food, it does not harm the stomach itself.

Food must travel from the mouth to the stomach via the esophagus, a tube that runs vertically through the torso. The lower esophageal sphincter is a valve that connects the esophagus and the stomach. When closed, it keeps acid in the stomach. When it opens, it allows swallowed food to enter the stomach. GERD occurs when the sphincter fails to close, allowing food and acid to travel in the opposite direction. The esophagus does not have the same natural protection against acid as the stomach. Acid harms the tissue, causes pain, and increases cancer risk and other digestive tract diseases.

What is the Difference?

  • GERD vs. Acid Reflux: Acid reflux happens to almost everyone at some point in life. Spicy foods, irritating beverages like alcohol, or a large meal can cause acid to flow up the esophagus. The hallmark signs are a sour taste in one’s mouth as stomach acid reaches the throat and heartburn. Reflux is a brief condition usually triggered by specific foods. Antacid tablets and over-the-counter medication soothe the symptoms. GERD is a condition in which an individual experiences acid reflux two or more times per week, and the symptoms persist despite treatment.
  • GERD vs. Heartburn: Everyone will occasionally experience heartburn, a sometimes intense burning sensation in the chest that radiates to the throat and neck. Heartburn is an initial symptom of many conditions, including GERD, heart attack, pregnancy, or ulcers. Older adults should monitor their heartburn and look for accompanying symptoms.
  • GERD vs. GER: Gastroesophageal Reflux (GER) causes the contents of a person’s stomach to reflexively backflow into the esophagus. GER can happen without causing any symptoms. In some cases, it results from temporary dysfunction of the esophageal sphincter. In other, the contents of the stomach are under too much pressure to contain. Unmanaged GER can lead to GERD later in life.
  • GERD vs. Gastritis: While GERD involves irritation of the esophagus, gastritis is irritation of the stomach. It can be symptomatic of a serious underlying condition or due to the overproduction of stomach acid. Gastritis symptoms include feeling full after eating only a few bites, nausea, vomiting, abdominal pain, bloating, and indigestion.

What are the Symptoms of GERD in Older Adults?

The symptoms of GERD are often dismissed by older adults as part of aging or misidentified as related to another condition. Elderly patients are also more likely to underreport the severity of their symptoms. In addition, many people have coped with the symptoms for so long that they overlook them.

  • Sour Taste: Many older adults experience a bitter or sour taste in the back of their throat as acid travels up the esophagus.
  • Weight Loss: While many older adults may attribute their diminished appetite and weight loss to aging, it can often indicate GERD. In many cases, the production of stomach acid and the rapid feeling of fullness with small amounts of food depresses an older adult’s nutritional intake, leading to other health problems.

Learn more about Nutrition in Older Adults

  • Backflow and Vomiting: The backflow of partially digested food and stomach acid can cause wet burps and a bitter backwash in the back of the throat. Older adults are more likely to vomit due to GERD. As the esophageal valve weakens with age and the stomach is less active, increased amounts of food particles, bile, and stomach acid are forced through the esophagus.

What Are the Causes of GERD in Older Adults?

GERD is a chronic condition that develops over time. As a person ages, its impact on overall health will worsen. While diet and genetics determine a person’s likelihood of developing GERD, older adults are more vulnerable.

  • Weakened Esophageal Sphincter: All muscle and tissue deteriorate with age, including parts of the digestive tract. Older adults are more likely to have weak or underactive esophageal sphincters, the muscle that keeps the stomach closed.
  • Lower Mucus Production: The digestive tract is coated in a protective mucus that guards tissue against stomach acid, bile, and food. Older adults naturally produce less mucus over time. This leads to increased irritation and susceptibility to food triggers for GERD.
  • Sedentary Lifestyle: Exercise and movement stimulate the digestive tract. As people age and become less physically active, cardiac health and metabolism slow. This slows digestion, irritating the stomach and increasing the likelihood of experiencing GERD.
  • Obesity: Older adults are more likely to carry excess weight around the abdomen. Obesity places pressure on the trunk, compressing the stomach and other digestive organs.
    Medications: Older adults are more likely to take maintenance medications to manage ongoing health conditions. Blood pressure, antidepressant, and opiate medications can all cause heartburn and reflux, leading to GERD.
  • Hiatal Hernia: Researchers estimate that 60% of older adults have a Hiatal hernia, in which a section of your stomach pushes through the diaphragm into the chest cavity. While not life-threatening, this displacement increases the occurrence of GERD and exacerbates the symptoms.

What Are the Natural Remedies for GERD?

Treatment for GERD focuses on symptom management. Unlike skeletal muscles, physical therapy cannot strengthen a damaged esophageal sphincter. Prescription and over-the-counter medications are used to manage acid production. Surgery is considered in severe cases that do not respond to medication. Lifestyle modifications and prevention are the best way to manage GERD.

Natural Remedies for GERD

  • Chamomile Tea: Herbal teas have been used for the span of human history as a treatment. Chamomile tea soothes the stomach and has anti-inflammatory properties which combat acid production.
  • Licorice Root: Deglycyrrhizinated (DGL) licorice may increase mucus production in the stomach. This helps neutralize stomach acid and prevent it from building up and entering the esophagus. Elderly patients should discuss herbal and alternative treatment with their doctor to rule out possible drug interactions.
  • Gum: Chewing gum elevates saliva production, helping to clear the throat and esophagus during GERD flare-ups.
  • Eat Small Meals: Large meals take longer to digest, spending more time in the stomach. Excessive intake places extra pressure on the esophageal sphincter. Having multiple small meals throughout the day allows the body to digest efficiently, reducing the stress on the stomach.

Foods to Avoid with GERD

In general, GERD sufferers should avoid acidic foods and other irritants that can upset the stomach. Older adults can develop new intolerances as they age. Caregivers and elderly patients should remove as many suspected triggers from the diet and slowly reintroduce them to pinpoint the exact problem foods. Foods to avoid include:

  • Tomatoes and related foods, like pasta sauce
  • Processed and high-fat foods, like fast foods
  • Fried foods
  • Juices from citrus, like orange juice
  • Sodas and other carbonated beverages
  • Caffeine, including coffee and tea
  • Chocolate
  • Garlic and onions
  • Alcohol

GERD and Sleep

One of the major effects of GERD is sleep disruption. One study reported that 78% of GERD patients experienced nocturnal symptoms.

Why is GERD Worse at Night?

GERD symptoms are often worst at night because:

  • Big Meals: Dinner is the largest meal of the day for many people. As a result, excessive stress is placed on the stomach and irritating foods settle.
  • Nighttime Snacking: Unhealthy snacking and alcohol consumption are also usually done in the evening. Digestion slows at night as the body prepares for sleep, allowing acid to build up in the stomach.
  • Gravity: When a person is standing or sitting up straight, stomach acid must travel vertically into the esophagus. When people lie down or recline in the evening, stomach acid has an easier pathway up the esophagus. Doctors recommend patients wait three to four hours after eating before lying down.

How to Sleep with GERD?

  • Earlier Meals: Older adults can reduce the intensity of GERD symptoms by eating larger meals earlier in the day and having a small dinner. Avoiding late-night snacks also reduces the irritation that stimulates acid production.
  • Elevate the Head: GERD sufferers make it harder for acid to travel up the esophagus by raising the head of their bed. One study reported symptom improvement in 65% of participants who slept with their heads elevated.
  • Sleep on the Left: Side-sleepers should lay on their left rather than their right. This position places the esophageal sphincter above the stomach, making it harder for acid to flow upwards. Sleeping on the right side allows easier backflow, which intensifies heartburn and other symptoms.

How to Help a Senior Loved One with GERD?

Caregivers should discuss the risks of unmanaged GERD with their loved ones and ask about their symptoms because seniors may ignore and cope with the condition. Helpful steps include:

  • Meal Planning: Keeping a food diary and planning meals that do not contain trigger foods can help limit GERD. Caregivers should advise seniors to eat a high-protein and low-carb diet.
  • GERD Pillow: Elevating the head and torso can help seniors with GERD sleep better. A GERD pillow is a firm wedge-shaped pillow that lifts the torso, shoulders, and head. They are lower-cost alternatives to adjustable beds and help prevent acid leakage into the esophagus during sleep.
  • Overnight Caregiver: Adults with mobility challenges or cognitive changes will benefit from overnight caregivers. Aides help prepare meals, remind seniors about proper sleeping positions, and monitor GERD symptoms. This care helps improve the senior’s quality of life and relays information to loved ones or doctors about the condition.

Learn how Home Care may help senior loves ones.

Conclusion

GERD is a common yet manageable condition that many seniors unfortunately overlook. As they age, changing symptoms and a lifetime of coping with gastric distress lead them to ignore the condition.

While occasional acid reflux, heartburn, and gastritis are inevitable, frequent or intensifying symptoms should not be ignored. Seniors should consult with their doctor to determine the proper over-the-counter or prescription medication for managing symptoms.

In most cases, preventative steps and lifestyle modifications can ease acid production and abdominal pressure, making the symptoms of GERD more manageable.

Sources

1. Effect of bed head elevation during sleep in symptomatic patients of nocturnal gastroesophageal reflux – Wiley Online Library

2. Management of Gastroesophageal Reflux Disease РAmerican Family Physician 

3. Gastroesophageal reflux disease: Important considerations for the older patients – National Library of Medicine

4. Mayo Clinic Q and A: Lifestyle changes may ease laryngopharyngeal reflux

5. What are the benefits of DGL?

6. A case of giant hiatal hernia in an elderly patient: When stomach, duodenum, colon, and pancreas slide into thorax – Science Direct

7. Obesity & GERD – NIH Public Access

8. Increased susceptibility of aging gastric mucosa to injury: The mechanisms and clinical implications РWorld Journal of Gastroenterology 

9. Gastroesophageal reflux disease (GERD) – Mayo Clinic

10. Definition & Facts for GER & GERD – National Institute of Diabetes and Digestive and Kidney Diseases

11. Heartburn – Cleveland Clinic

12. Acid Reflux & GERD – Cleveland Clinic