The reality of care for older patients with Crohn's disease and ulcerative colitis

A review summarises the current state of care for older people with IBD – from treatment response and symptoms to quality of life and psychological stress.

Important findings on elderly care for IBD

The data on quality of life in old age with IBD is inconsistent. It is not clear whether those affected suffer more from the disease than younger people.
The symptoms differ in some respects from those in younger people, especially in Crohn's disease.
Comorbidities are more common, particularly cardiovascular, metabolic and pulmonary diseases.
Biologics are used, but with sometimes reduced efficacy and more treatment discontinuations.
Specialist medical care is patchy, especially in rural areas – with negative consequences.
Psychological stress is rarely recorded, but is relevant to the course of the disease and quality of life.

Inconsistent results on quality of life

Several studies show that older people with IBD have a reduced health-related quality of life. However, the findings are not consistent: for example, an American research group reports a comparatively good mental and disease-related quality of life, with a reduced physical component. A Canadian study, on the other hand, found no direct link between quality of life and age.

IBD symptoms in old age

The symptoms sometimes differ significantly from those of younger people with IBD:

In Crohn's disease, a colorectal localised, non-penetrative form predominates. Perianal manifestations are less common, while rectal bleeding occurs more frequently. Systemic symptoms such as fever or pain are also often less pronounced. Some studies also point to an increased prevalence of micronutrient deficiencies (iron, vitamin B12 and vitamin D).
In ulcerative colitis, the course in older patients is similar to that in younger patients, with a slightly reduced incidence of proctitis.

In addition, several studies report a high comorbidity burden, regardless of the IBD subtype. In a Dutch cohort, for example, 40% of people over the age of 65 with active disease showed pronounced deficits in somatic, functional, social and cognitive areas.

Drug therapy: lower response rates in some cases with biologics

Biologics such as anti-TNF, vedolizumab and ustekinumab are increasingly being used in older IBD patients. However, the overview shows that response rates and adherence are often reduced, and treatment discontinuations and infections are more common. The results for vedolizumab and ustekinumab are inconsistent – differences between the drug groups are not consistent.

Surgical procedures with increased risk?

The data on surgery in older people are also heterogeneous. Older patients with ulcerative colitis showed an increased risk of colectomy in some cases. The findings for people with Crohn's disease were inconsistent. In individual studies, postoperative complications were observed more frequently in older patients, including infections, cardiovascular events and increased mortality rates.

Reality of care: gaps in specialist care in rural areas

According to one study, older people with IBD have a higher risk of hospitalisation, especially in the first few years after diagnosis. Another interesting finding from a different study is that older people with IBD receive less frequent gastroenterological care, especially in rural areas. Studies have demonstrated the benefits of such care: under specialist supervision, hospitalisation rates fall, biologic therapy is used more frequently and surgical interventions are less common.

Mental health rarely addressed

Mental impairments were rarely recorded in the studies analysed. In a Dutch analysis, 17% of older patients showed cognitive deficits or depressive symptoms – especially in cases where the disease had developed late in life. A US study found that high disease activity is frequently associated with depression, which in turn is linked to lower adherence. A qualitative study emphasised the influence of social isolation as a consequence of the disease on emotional well-being.

Conclusion: IBD in old age poses its own challenges

The systematic review shows that older people with IBD have specific care needs that differ in part from those of younger people. Important aspects include therapy, psychosocial care and the integration of geriatric aspects. Individualised strategies are needed to improve the care of this growing patient group.

Source

Davis SP, McInerney R, Fisher S, Davis BL. Therapeutic needs of older adults with inflammatory bowel disease (IBD): A systematic review. Gastroenterol Insights. 2024;15(3):835–864. doi:10.3390/gastroent15030059