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

Abstract

Background: The 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.

Aims: To 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.

Methods: An 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.

Results: Of 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.

Conclusions: Components 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.

Keywords: Crohn’s disease; comprehensive geriatric assessment; ulcerative colitis.

Figure 1.

Flowchart.

Figure 2.

Visual representation of associations described in the included studies. A: percentage of associations described per component of a comprehensive geriatric assessment. No association reported on cognitive impairment, functional decline, or frailty. B: percentage of associations described per adverse health outcome measurement. No association described functional or cognitive decline as an outcome measurement. [HR]QoL, health-related quality of life.

Figure 3.

Visual representation of significant associations. Positive significant associations are associations in which more geriatric impairment led to more adverse outcomes, negative significant associations in which more geriatric impairment led to less adverse outcomes. A: percentage of significant associations in associations of all included studies. B: percentage of significant associations in associations of the six largest studies.

Figure 4.

The detected effect of geriatric impairments on adverse health outcomes in inflammatory bowel disease patients. No studies on functional or cognitive impairment were found.

Figure 5.

Graphic representation of associations of somatic or physical impairment, depressive and/or anxiety symptoms, and social impairment with adverse health outcomes in inflammatory bowel disease patients. No studies reported on cognitive impairment, functional impairment, or frailty.

Figure 6.

Potential pathophysiological interactions between components of a comprehensive geriatric assessment and inflammatory bowel disease [IBD] -related disease outcomes.