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12 Sep

IBD (Ulcerative Colitis and Crohn’s disease) in old age – 15 things to watch out

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  1. New onset IBD in old age along with younger diagnosed patient getting older, it is estimated that by 2033, 1 in 3 IBD patient will be above 60 years
  2. There is no typical IBD patient. There are various ways that IBD can affect a patient; some 60-year olds will have the same physical capacities as many 20-years-old IBD patients. Other people experience declines in physical and different abilities at much younger ages.
  3. Late-onset IBD differs from early onset in many aspects, including location and phenotype of the disease at diagnosis, symptoms at presentation, and natural disease progression
  4. Limited coordination skills may impact the patient’s ability to successfully self-administer topical treatment like suppositories.
  5. Diagnostic challenges : There are different mimics of IBD like infectious colitis, segmental colitis associated with diverticular disease, nonsteroidal anti-inflammatory drug-induced intestinal injury and ischemia.
  6. There is need for more scientific research. Only small proportion of participants enrolled in IBD clinical trials are made up of people with IBD aged 60 years and over. This results in underutilized appropriate therapeutic management decisions in this population
  7. Comorbidities: People with IBD aged 60 years and over have many comorbidities like blood pressure , Diabetes , Heart diseases, neurological diseases. Surgical management has more risk than young age.
  8. Polypharmacy: Given the higher incidence of age-related comorbidities, people with IBD aged 60 years and over are more likely to take a wide range of medicines . Drug interactions need to consider in prescription. Risks of the immunosuppressant drugs is more as low immunity and nutrition issues more in old age.
  9. Cognitive decline and Neurological diseases are common in old age . These leads to poor adherence to therapy and cooperation in disease management
  10. Unequal access to treatment as compared to young age as many old age people require support in travel, administering Medications.
  11. Colonoscopy procedure is slightly more risky in old age due to difficulty in bowel preparation, mobility issues, Multiple comorbidities, anaesthesia related issue.
  12. Lower life expectancy in elderly IBD as compared with patients without IBD
  13. Frailty defined as a state of decreased physiological reserve. This was independently predictive of worsening mobility, hospitalization , post operative complications, Infections.
  14. Inflammaging: Cellular aging leads to state of chronic inflammation. This is related to biological aging. This inflammaging is more pronounced in IBD patients. This further aggravates the egeing related disorders in IBD patients. There is more prevalence of dementia , DM , Cardiovascular diseases , Osteoporosis.
  15. Prescription and Management : Core strength exercises , Nutrition, Limit polypharmacy , Home interior to suite old age to prevent fall.

 

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