3.1. Background Analysis
A total of 75 adult patients with complicated diverticular disease were included in the final analysis, as well as 53 elderly patients with acute diverticulitis and 52 controls with uncomplicated symptomatic diverticular disease. The background analysis presented in
Table 1 highlights several variables, including age, gender, area of residence, smoking status, pack-year smoking, the number of patients with obesity, patients who admitted having a low-fiber diet and chronic constipation, as well as the Charlson Comorbidity Index (CCI) score. The mean age of the adult group was 52.1 ± 9.0 years, while the elderly group’s mean age was 69.6 ± 3.8 years. The control group had a mean age of 63.7 ± 8.5 years. There was a statistically significant difference in age between the groups (
p < 0.001). The percentage of females in the adult, elderly, and control groups were 55.7%, 61.7%, and 54.3%, respectively, with no statistically significant difference between the groups (
p = 0.502).
There was no statistically significant difference between the groups for the urban area of residence (p = 0.902), with 51.0% in the adult group, 48.6% in the elderly group, and 51.4% in the control group. No significant difference was observed in smoking status (p = 0.775) or pack-year smoking (p = 0.671) between the groups. The prevalence of obesity was similar across the groups, with 28.2% in the adult group, 27.1% in the elderly group, and 31.4% in the control group, with no statistically significant difference between them (p = 0.766). Additionally, no statistically significant difference was observed in the prevalence of low-fiber diet between the groups (p = 0.923). The prevalence of chronic constipation was 19.5% in the adult group, 22.4% in the elderly group, and 25.7% in the control group, with no statistically significant difference between them (p = 0.496). Lastly, no significant difference was observed between the groups for Charlson Comorbidity Index scores greater than 3 (p = 0.110), with 13.4% in the adult group, 23.4% in the elderly group, and 20.0% in the control group.
3.2. Diverticular Disease Characteristics
Table 2 presents the characteristics of diverticular disease among the three study groups. The median bowel movements per day were 2.0 (IQR: 1–5) for adults, 1.0 (IQR: 0–4) for the elderly, and 1.5 (IQR: 0–2) for the control group. The difference between the groups was not statistically significant (
p = 0.206). The number of days per week of loose bowel movements was 3.0 (IQR: 1–6) for adults, 2.0 (IQR: 0–5) for the elderly, and 1.0 (IQR: 0–3) for the control group. The difference was not statistically significant (
p = 0.148). The number of days per week of hard bowel movements was 2.0 (IQR: 0–3) for adults, 3.0 (IQR: 1–5) for the elderly, and 4.0 (IQR: 1–7) for the control group. The difference was not statistically significant (
p = 0.227). The number of days per week of pain was significantly higher in adults (4.0, IQR: 1–7) and the elderly (4.5, IQR: 2–7) than in the control group (2.0, IQR: 0–3) (
p = 0.030).
The Hinchey classification was not significantly different between adults and the elderly (p = 0.158). The majority of patients in all groups were under Hinchey 1b classification (74.7% in adults vs. 62.3% in the elderly). The treatment options were significantly different between the groups, since intravenous (IV) antibiotics were given to 81.2% of adults, 87.9% of the elderly, and 17.1% of the control group. Oral antibiotics were given to 24.2% of adults, 20.6% of the elderly, and 70.5% of the control group. Anti-inflammatory drugs were given to 53.0% of adults, 41.1% of the elderly, and 64.8% of the control group. A liquid diet was given to 58.4% of adults, 64.5% of the elderly, and 21.9% of the control group. Stool softeners were given to 51.0% of adults, 67.3% of the elderly, and 76.2% of the control group. IV fluids were given to 65.8% of adults, 75.7% of the elderly, and 37.1% of the control group. The p-values for the comparison between adults and the elderly were calculated for each treatment option. IV antibiotics, oral antibiotics, and anti-inflammatory drugs showed significant differences (p < 0.05). However, liquid diet, stool softeners, and IV fluids did not show significant differences (p > 0.05).
3.3. Analysis of Standardized Questionnaires
At diagnosis, the mean physical score for adults was 54.3 ± 7.6, while the elderly group had a slightly lower mean score of 51.9 ± 8.0, and the control group had the highest mean score of 56.8 ± 7.3. The difference between the groups was statistically significant, with a
p-value of <0.001. When comparing only adults and the elderly, the
p-value was 0.015, indicating a significant difference between these two groups. The mental score at diagnosis showed a similar pattern, with the adult group having a mean score of 52.1 ± 8.1, the elderly group having a mean score of 56.0 ± 6.7, and the control group having a mean score of 57.5 ± 6.9, as seen in
Figure 1. The difference between the groups was also statistically significant (
p-value < 0.001), and the difference between adults and the elderly remained significant with a
p-value of <0.001. For the total SF-36 score at diagnosis, the adult group had a mean score of 55.9 ± 8.4, the elderly group had a mean score of 53.7 ± 7.4, and the control group had a mean score of 57.2 ± 6.4. The difference between the groups was statistically significant (
p-value < 0.001), and the difference between adults and the elderly was also significant, with a
p-value of 0.030.
At the 6-month follow-up, the mean physical score for adults increased to 55.9 ± 7.2, the elderly group had a mean score of 53.8 ± 8.0, and the control group had a mean score of 57.2 ± 6.8. The difference between the groups remained statistically significant (
p-value < 0.001), and the difference between adults and the elderly was also significant, with a
p-value of 0.028. The mental score at the 6-month follow-up also increased for all groups: adults had a mean score of 55.2 ± 8.5, the elderly group had a mean score of 56.6 ± 6.9, and the control group had a mean score of 58.4 ± 7.3. The difference between the groups was statistically significant (
p-value = 0.005), but the difference between adults and the elderly was not significant (
p-value = 0.161). Lastly, the total SF-36 score at the 6-month follow-up showed an increase for all groups: adults had a mean score of 56.7 ± 8.0, the elderly group had a mean score of 55.9 ± 7.8, and the control group had a mean score of 57.7 ± 7.5. The difference between the groups was not statistically significant (
p-value = 0.243), and the difference between adults and the elderly was also not significant (
p-value = 0.426), as seen in
Table 3.
In our paired comparison analysis, we observed significant improvements in both physical and mental scores for the adults group (n = 75) at the 6-month follow-up compared with their scores at diagnosis. The physical scores increased by a mean difference of 1.6 (p-value = 0.013), while the mental scores improved by a mean difference of 3.1 (p-value < 0.001). For the elderly group (n = 53), we found a significant improvement in their physical scores, with a mean difference of 1.9 (p-value = 0.027), and total scores, with a mean difference of 2.2 (p-value = 0.012). However, there was no significant change in their mental scores. Notably, there were no significant changes in any of the scores for the control group (n = 52). These findings suggest that patients with diverticular disease, particularly in the adults and elderly groups, experienced improvements in physical and mental health aspects over the course of 6 months, indicating a positive response to the treatment or management strategies employed.
At diagnosis, the mean GIQLI score for the adult group was 118 ± 14.6, while the elderly group had a lower mean score of 111 ± 12.2, and the control group had the highest mean score of 124 ± 10.8. The difference between the groups was statistically significant, with a p-value of <0.001. When comparing only adults and the elderly, the p-value was <0.001, indicating a significant difference between these two groups. The median GIQLI score at diagnosis showed a similar pattern. The adult group had a median score of 120 with an interquartile range (IQR) of 104–136, the elderly group had a median score of 113 with an IQR of 98–125, and the control group had a median score of 128 with an IQR of 109–131. The difference between the groups was statistically significant (p-value <0.001), and the difference between adults and the elderly remained significant with a p-value of <0.001.
At the 6-month follow-up, the mean GIQLI score for adults increased to 125 ± 12.7, the elderly group had a mean score of 122 ± 13.5, and the control group had a mean score of 129 ± 12.0. The difference between the groups remained statistically significant (
p-value <0.001), but the difference between adults and the elderly was not significant (
p-value 0.070). The median GIQLI score at the 6-month follow-up also increased for all groups: adults had a median score of 124 with an IQR of 109–132, the elderly group had a median score of 115 with an IQR of 106–128, and the control group had a median score of 131 with an IQR of 114–138. The difference between the groups was statistically significant (
p-value <0.001), and the difference between adults and the elderly remained significant with a
p-value of <0.001, as described in
Table 4.
Table 5 presents the results of an analysis of the HADS questionnaire for three groups of participants at diagnosis and six months after the initial survey. The HADS questionnaire is a measure of anxiety and depression, where higher scores indicate greater levels of anxiety or depression. The table presents the mean scores for anxiety, depression, and total scores at diagnosis and at six months, as well as the
p-value for each comparison. At diagnosis, the anxiety score for the group of adults was significantly higher than that of the control group, with a
p-value of 0.009. However, there were no significant differences in anxiety scores between any of the groups for the elderly group or the total score, as seen in
Figure 2. Additionally, there were no significant differences in depression scores between any of the groups at diagnosis. At 6 months, there were no significant differences in anxiety scores between any of the groups. There were also no significant differences in depression scores between any of the groups, except for a marginally significant difference between the adults and elderly groups, with a
p-value of 0.157.
At diagnosis,
Table 6 shows that adults had a higher mean score for positive perceived stress (6.71) compared with the elderly (5.97) and control (5.32) groups (
Figure 3). This difference was statistically significant (
p = 0.020). On the other hand, for negatively perceived stress, the elderly group had a higher mean score (6.81) compared with the adults (5.94) and control (5.66) groups, and this difference was also statistically significant (
p = 0.007). However, the total score did not differ significantly among the three groups (
p = 0.125). At the 6-month follow-up, there was no significant difference in positive perceived stress scores among the three groups (
p = 0.201), although the elderly group had the highest mean score (7.09). For negatively perceived stress, the elderly group had a higher mean score (6.14) compared with the adults (5.44) and control (5.28) groups, but the difference was not statistically significant (
p = 0.124). The total score did not differ significantly among the three groups (
p = 0.134). Overall, there were significant differences in perceived stress scores between adults and elderly groups at diagnosis for negatively perceived stress (
p = 0.022) and at the six-month follow-up for positive perceived stress (
p = 0.006).