Management of Inflammatory Bowel Disease in the Elderly Patient

Abstract

The population of older patients with inflammatory bowel disease (IBD) continues to grow, partly reflecting the aging global population in general. The debilitating effects of IBD compound age-related decrements in health and functional capacity, and make the medical management of older patients with Crohn’s disease and ulcerative colitis distinctly challenging to clinicians. Here, we review the recent literature describing the pharmacologic management of IBD in this population, with focus on the safety, tolerability, and efficacy of common treatment options, such as steroids, immunomodulators, tumor necrosis factor-α antagonists, and integrin antagonists; surgical interventions in older patients are also discussed. Few studies have systematically and prospectively evaluated the clinical challenges in the medical management of IBD in this patient population, leaving a limited evidence base to which clinicians can turn to for guidance. Treatment patterns may thus be suboptimal. For example, prolonged steroid use in the elderly was found to be common, causing significant morbidity from side effects in a particularly vulnerable population. Finally, within the context of a limited evidence base, we discuss common treatment scenarios to define the parameters within which physicians can individualize care for older patients with IBD. Overall, older IBD patients are at higher risk of adverse events and less treatment responsiveness compared with younger patients, underscoring the need for future studies to fully characterize appropriate treatment courses for this population.

Comparative safety and effectiveness of tumor necrosis factor α antagonists and vedolizumab in elderly IBD patients: a multicentre study

“…However, such immunosuppression may be associated with rare but serious adverse effects including infections and treatment‐related cancers. One population that is particularly vulnerable to such adverse effects but is frequently excluded from clinical trials and observational cohorts is the older IBD patient …”

“…Up to one‐fifth of patients with IBD may be diagnosed after the age of 60 years . Owing to the ageing of the population, patients older than age 60 years represent a growing subgroup of those with IBD globally . Studies have demonstrated that IBD in older patients is associated with significant morbidity.…”

Editorial: is age just a number when it comes to treatment of inflammatory bowel disease?

“…1 Managing older IBD patients poses unique challenges for clinicians, who must balance the benefits of chronic immunosuppression with a higher burden of patient comorbidity and risks of treatment-and disease-related adverse events (AEs). 2 Asscher et al recently reported results from the prospective Dutch Initiative on Crohn's Colitis (ICC), comparing the effect of comorbidity and age on impaired safety outcomes in IBD patients treated with second generation biologics. 3 Among 203 vedolizumab-and 207 ustekinumab-exposed patients, comorbidity burden was independently associated with negative safety outcomes, particularly hospitalisations, whereas age was not.…”

Early combined immunosuppression may be effective and safe in older patients with Crohn’s disease: post hoc analysis of REACT

“…Approximately 10%‐30% patients with IBD are older than 60 years, and with an aging population and chronic nature of IBD, the prevalence of IBD in older adults is anticipated to continuously rise . Based on the 2015 National Health Interview Survey, an estimated 1.7% adults ≥65 years (approximately 805 000) reported a diagnosis of IBD .…”