Therapeutic Needs of Older Adults with Inflammatory Bowel Disease (IBD): A Systematic Review

Abstract

Background/Objective: Inflammatory bowel disease (IBD) diagnosis in the elderly falls under two categories: those diagnosed at a younger age and transitioning to the elderly group (>60 years) and those diagnosed at ≥60 years of age. Although it is difficult to calculate the incidence of IBD among elderly adults precisely, it is estimated that around 10–15% of IBD in the US are diagnosed after 60 years, and approximately 13% of IBD cases are diagnosed after the age of 65 globally. The objective of this systematic review is to assess the therapeutic needs of elderly adults with IBD, focusing on quality of life (QOL), symptom presentation, mental health management, IBD medication utilization patterns, surgical outcomes, and healthcare utilization to identify gaps in IBD management. Methods: We identified 42 published articles through a database search using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses from October 2023 to June 2024. We conducted the quality appraisal of the selected studies using the Joanna Briggs Institute (JBI) critical appraisal tools. Results: Our findings indicate decreased health-related QOL, more colonic and less penetrating disease in elderly Crohn’s disease patients, and comparable symptoms between elderly and younger ulcerative colitis patients. Despite an increased trend in prescribing biologics, the elderly show decreased response rates and poor remission. Higher healthcare utilization is noted among elderly IBD patients, alongside insufficient attention to their mental health concerns. Conclusions: The findings from this systematic review offer a comprehensive synthesis of the management of elderly adults with IBD and highlight several unmet needs that warrant attention in future research and clinical practice considerations.