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. 2023 Oct;53(10):1866-1874.
doi: 10.1111/imj.15928. Epub 2022 Sep 29.

Clinical outcomes amongst elderly patients with inflammatory bowel disease

Vithoosharan Sivanathan  1 , Chamara Basnayake  1   2 , William Connell  2 , Emily Wright  1   2 , John Nik Ding  1   2 , Ola Niewadomski  2 , Annalise Stanley  2 , Amy Wilson-O'Brien  1   2 , Stephanie Fry  2 , Tamie Samyue  2 , Mark Lust  2 , Emma Flanagan  1   2 , Alexander J V Thompson  1   2 , Michael A Kamm  1   2
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Clinical outcomes amongst elderly patients with inflammatory bowel disease

Vithoosharan Sivanathan et al. Intern Med J. 2023 Oct.

Abstract

Backgrounds and aims: Inflammatory bowel disease (IBD) affects a growing cohort of elderly patients. Our aim was to compare the quality of care received by elderly patients with IBD with a nonelderly adult IBD population using clinical markers including steroid-free clinical remission.

Method: Retrospective audit of all consecutive patients attending a specialist IBD centre over a 1-year period aged >60 (elderly cohort [EC]) and 50 consecutive patients aged 30-45 years (control cohort [CC]). A follow-up survey was completed assessing current symptoms and perceptions of care.

Results: One hundred thirty-nine patients were evaluated (89 EC, 50 CC). Steroid-free clinical remission was observed less commonly in the EC (58, 64%) compared with the CC (40, 80%) (P < 0.05). Biologics such as infliximab (15% EC vs 36% CC; P < 0.01) and adalimumab (14% EC vs 30% CC; P = 0.02) were used less frequently in the EC, whilst vedolizumab (6% EC vs 6% CC; P = 1) and ustekinumab (3% EC vs 2% CC; P = 1) were used at a similar frequency. Patients in the EC were less likely to have specialist IBD nursing contact (P < 0.01), smoking screening (P < 0.011) or influenza vaccinations (P < 0.006). IBD nurse contact was associated with significantly greater provision of the preventative care measures.

Conclusion: Elderly patients with IBD were less likely to experience steroid-free clinical remission or be prescribed biologics. Elderly patients were less likely to receive education with respect to preventative medicine. The models of care for the elderly need re-evaluation and greater incorporation with the multidisciplinary IBD team.

Keywords: Crohn's; elderly; inflammatory bowel disease; quality of care; ulcerative colitis.

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References

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