Deficits in Geriatric Assessment Associate With Disease Activity and Burden in Older Patients With Inflammatory Bowel Disease

Abstract

Somatic domain 52% abnormal (instrumental) Activities of daily living 43% abnormal Physical capacity 23% abnormal Mental domain 17% abnormal Social domain 24% abnormal Geriatric Assessment 5 domains IBD patients aged ≥65 N=405 53% 39% 8%

Elderly onset age is associated with low efficacy of first anti-tumor necrosis factor treatment in patients with inflammatory bowel disease

“…Third, fecal calprotectin levels were not measured because it had not been approved by insurance for patients with CD in Japan. Forth, we could not assess the frailty which was reported to affect disease activity, and treatment efficacy and safety in elderly patients with IBD 32 , 33 . To address these issues, a prospective study with comorbidities, frailty, endoscopic and fecal evaluation is needed.…”

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

“…161,162 Several tools have been used in IBD to assess frailty, such as Frailty Risk Score, International Classification of Diseases codes, Fried frailty phenotype criteria, the simplified Frailty Index score, and the Hospital Frailty Risk Score; however, these indices are based on cumulative deficits and do not incorporate a comprehensive assessment of the different domains of functional capacities. 155,163,167,[178][179][180][181] Simple, fast, and effective tools are needed to enable a more standardised geriatric assessment. The development and validation of such indices would take time.…”

“…The development and validation of such indices would take time. We could, while waiting for these, evaluate patients with IBD by building on the Comprehensive Geriatric Assessment proposed by Asscher and colleagues 181,182 which explores different geriatric domains reflecting a patient's health, including We summarise a proposal for the inclusion of older adults with IBD in clinical trials (panel panel), which we hope will be further investigated. On the basis of the tools proposed by Asscher and colleagues, 181 we propose, as a first step, to include patients with preserved somatic function in clinical trials.…”

“…We could, while waiting for these, evaluate patients with IBD by building on the Comprehensive Geriatric Assessment proposed by Asscher and colleagues 181,182 which explores different geriatric domains reflecting a patient's health, including We summarise a proposal for the inclusion of older adults with IBD in clinical trials (panel panel), which we hope will be further investigated. On the basis of the tools proposed by Asscher and colleagues, 181 we propose, as a first step, to include patients with preserved somatic function in clinical trials. These patients could be identified by: the absence of malnutrition risk or a score of more than 11 on the Mini-Nutritional Assessment short form; 183 a low Charlson Comorbidity Index, which considers the number and severity of 16 predefined comorbidities 184 (as higher Charlson Comorbidity Indices are associated with higher risk of infection 185 in patients with IBD, and increased post-colonoscopy hospitalisation 186 ); and the absence of polypharmacy-preferably five or fewer non-IBD prescription medications 187 (as polypharmacy, which is frequent in patients with IBD, 188,189 can lead to drug-drug interactions that could affect the efficacy and safety of IBD medication and can affect a patient's adherence to treatment 18 ).…”

Perspectives on Treatment of Inflammatory Bowel Disease in Older Patients: Applying Gut-Feeling in an Evidence-Based Era?

“…To ensure a heterogenous population, purposive sampling was applied by selecting older patients from the authors' cohort study on geriatric assessment in older patients with IBD. 21 In this way, the authors could select patients based on information in the electronical medical record, such as age, sex, IBD disease history, disease duration, IBD medication, and place of living, and based on frailty, comorbidity, and educational level. All patients were included after signing informed consent and agreeing to having the interview audio taped.…”