Aging and IBD: A New Challenge for Clinicians and Researchers

Abstract

Evidence from recent epidemiological data suggests that the patient population with inflammatory bowel disease (IBD) is chronologically aging. As these individuals become older, cellular senescence leads to a state of chronic inflammation. This process, known as inflammaging, is thought to be closely linked with biological aging and may be upregulated within IBD. As a consequence, we see an increased risk of aging-related disorders within IBD. In addition, we see that frailty, which results from physiologic decline, is increasing in prevalence and is associated with adverse clinical outcomes in IBD. As such, in this review we explore the potential overlapping biology of IBD and aging, discuss the risk of aging-related disorders in IBD, and describe frailty and its relation to clinical outcomes within IBD. Finally, we discuss current considerations for clinical care and potential research avenues for further investigation.

Association Between Inflammatory Bowel Disease and Dementia: A Longitudinal Cohort Study

“… 3 Meanwhile, as a protracted course of disease with no known cure and limited excess mortality, the prevalence of IBD is predominantly high in the elderly, accounting for approximately one-third of IBD patients. 4 …”

Mortality in Patients with Inflammatory Bowel Disease: Results from 30 Years of Follow-up in a Norwegian Inception Cohort (the IBSEN study)

“…38,39 Long-term ongoing chronic inflammation exacerbates the risk of cardiovascular disease, which could explain why the increased mortality was detected for the first time after 30 years of follow-up of the IBSEN study. 14,40 In patients with CD, male sex, diagnosis after 40 years of age and colonic disease result in higher mortality. This association was also observed in a comparable Danish cohort.…”

“…[6][7][8][9][10][11][12][13] Although treatments and clinical strategies have gradually improved, particularly with the emergence of tumour necrosis factor [TNF]-α inhibitors, the rising proportion of elderly patients poses new challenges. [14][15][16][17] For example, therapeutics that compromise the immune system may raise the risk of serious infections or malignancies in elderly patients. [18][19][20][21][22] Studies centered on elderly IBD patients repeatedly found increased mortality rates.…”

Is it time to include older adults in inflammatory bowel disease trials? A call for action

“…[154][155][156][157][158] Although chronological age and comorbidities are often used in risk stratification tools, recent data suggest that frailty might be a better comprehensive assessment of an individual's risk of adverse health outcomes. [159][160][161][162] The prevalence of frailty increases with age, and patients who are frail present with more comorbidities; however, advanced chronological age, multimorbidity, and frailty are not synonyms. 163 Proinflammatory cytokines have a role in the pathophysiology of frailty, which is particularly relevant to consider in chronic inflammatory diseases such as IBD.…”