Frailty is increasingly recognized as an important concept in patients with Inflammatory Bowel Disease (IBD). The aim of this scoping review is to summarize the current literature on frailty in IBD. We will discuss the definition of frailty, frailty assessment methods, the prevalence of frailty, risk factors for frailty and the prognostic value of frailty in IBD. A scoping literature search was performed using the PubMed database. Frailty prevalence varied from 6% to 53.9%, depending on the population and frailty assessment method. Frailty was associated with a range of adverse outcomes, including an increased risk for all-cause hospitalization and readmission, mortality in non-surgical setting, IBD-related hospitalization and readmission. Therefore, frailty assessment should become integrated as part of routine clinical care for older patients with IBD.

Background Fatigue is a common and debilitating symptom experienced by patients with inflammatory bowel disease (IBD). Studies focusing on fatigue in IBD were conducted in a relatively young population. However, little is known about the prevalence and factors associated with fatigue in the older population with IBD and how it relates to frailty. Methods The aim of this study was to determine the prevalence of fatigue and to identify factors associated with fatigue in older patients with IBD. Data were used from a prospective, multicenter cohort study, that included both older patients with IBD (aged > 65 years) and younger patients with IBD (aged < 65 years). Patients aged < 65 years served as a control group to compare the fatigue prevalence found in older patients. A geriatric assessment (including the Geriatric 8 (G8) questionnaire) was performed to measure frailty at baseline in older subjects. Fatigue was evaluated using one item from the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Univariable and multivariable regression analysis were performed to assess factors associated with fatigue in older patients with IBD. Active disease was defined as the presence of clinical or biochemical disease activity. Results Fatigue prevalence in 405 older patients with IBD varied between 45.8% (71/155) in patients with active disease to 23.6% (59/250) in patients with disease in remission. In younger patients, fatigue prevalence varied between 59.5% (47/79) in active disease to 55.3% (42/76) in disease in remission. Multivariable analysis showed a significant association between fatigue and depression (Odds ratio (OR) 2.98, 95% confidence interval (CI) 1.23-7.17), sleeping disturbances (OR 4.25, 95% CI 2.40-7.54), use of immunomodulators (OR 2.24, 95% CI 1.15-4.38), and an abnormal frailty screening (G8) (OR 2.02, 95% CI 1.14-3.57). Frailty measured by geriatric assessment (OR 2.47, 95% CI 1.49-4.12) was also independently associated with fatigue. No association was found between fatigue and disease activity in multivariate analysis. Conclusion Fatigue has a lower prevalence in older patients with IBD compared to younger patients with IBD, but the prevalence increased sharply when active disease is present. Fatigue in older patients is associated with depression, sleeping disturbances and use of immunomodulators. Moreover, both risk of frailty in frailty screening and frailty measured in a geriatric assessment associate with fatigue in older patients with IBD.