Systematic Review: Components of a Comprehensive Geriatric Assessment in Inflammatory Bowel Disease—A Potentially Promising but Often Neglected Risk Stratification

Abstract

BackgroundThe population of older patients with inflammatory bowel disease [IBD] is increasing. Patient age does not fully account for poor outcomes and its clinical utility for risk stratification is limited. Comprehensive geriatric assessment [CGA], comprising a somatic, functional, mental, and social assessment or frailty, could be a predictor tool.AimsTo systematically review literature on the kind of components of a CGA being used in adult IBD patients and the association of these components with adverse health outcomes.MethodsAn electronic literature search was performed on January 16, 2018, using PubMed, Embase, Web of Science, the Cochrane Library, CENTRAL, Emcare, and PsycINFO. Longitudinal studies relating somatic, functional, mental, and social assessment or frailty to adverse health outcomes during follow-up in IBD patients were included. The Newcastle-Ottawa scale was used to assess individual study quality.ResultsOf 4080 identified citations, 27 studies were included, reporting 169 associations. Median sample size was 108 patients (interquartile range [IQR] 60–704). No studies performed subgroup analyses on older patients, and the highest mean age reported was 52.7 years. Somatic and functional assessments were used in three studies, mental in 24, and social in five. No study assessed cognitive status, functional performance, or frailty. In 62 associations [36.7%], components of a CGA were significantly associated with adverse health outcome measurements.ConclusionsComponents of a CGA were associated with adverse health outcomes in IBD patients, but older patients were under-represented. More studies among older patients with IBD are warranted to further establish the clinical impact of a CGA.

Serum triiodothyronine‐to‐thyroxine (T3/T4) ratio predicts therapeutic outcome to biological therapies in elderly IBD patients

“…Indeed, ageing is frequently associated with a reduction of lean muscle mass, particularly in IBD patients. 36 In previous studies, the depletion of lean muscle mass (ie sarcopenia) was associated with lower response rates to biological therapy, predicting the need for surgery. 22,40 Of note, the conversion of fT3 into fT4 is due to the activity of deiodinase D2, located mainly in muscles.…”

“…20 Despite no previous studies had evaluated this biomarker in IBD patients, a recent review showed that frail elderly patients are more susceptible to the complications of IBD and display lower healing capacity. 36 Of note, although the pathophysiology of frailty is still debated, a chronic inflammatory condition seems to play an important role. Indeed, a study by Hubbard et al 37 showed that elevated serum levels of the pro-inflammatory cytokines IL-6 and TNF were correlated with frailty in elderly patients and, consequently, to a worst outcome.…”

“…The correlation between T3/T4 ratio and therapeutic outcome, as observed in the present study, could be explained by the typical modifications of body composition occurring in elderly patients. Indeed, ageing is frequently associated with a reduction of lean muscle mass, particularly in IBD patients 36 . In previous studies, the depletion of lean muscle mass (ie sarcopenia) was associated with lower response rates to biological therapy, predicting the need for surgery 22,40 .…”

“…The T3/T4 ratio has been described as an independent marker of frailty in elderly patients 20 . Despite no previous studies had evaluated this biomarker in IBD patients, a recent review showed that frail elderly patients are more susceptible to the complications of IBD and display lower healing capacity 36 . Of note, although the pathophysiology of frailty is still debated, a chronic inflammatory condition seems to play an important role.…”

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

“…Unfortunately, little evidence is available on frailty in IBD patients. Components of a geriatric assessment and retrospectively assessed frailty are associated with negative health outcomes in IBD patients 4‐6 . Measuring the level of frailty using a geriatric assessment could very well close the gap between a general ‘gut‐feeling’ and applying evidence‐based medicine when it comes to treatment strategies in older patients with IBD.…”