IBD can affect retired folks too
While most of those with IBD <<(inflammatory bowel disease)>> develop <<Crohn's disease>> or <<ulcerative colitis>> (UC) in their 20's and 30's, infants, children, teens and even those between the ages of 50 and 70 have been diagnosed. In fact, estimates suggest that 10%-30% of IBD patients are over 60 years old, referred to as late-onset IBD.
Even though IBD is increasing in those over 60, they are rarely included in clinical trials, because they often have other illnesses and take other medicines that may be restricted in research studies. As a result, little is known about how those over 60 are the same or different than those who are younger and how they will react to new medicines.To make matters worse, being on medicines for their other illnesses can cause drug interactions between treatment for their IBD and their other conditions. And that can lead to worsening of the either or both problems.
Often a delay in recognizing Late-onset IBD
Those over 60 are also 4 times more likely to be misdiagnosed than younger IBD patients and their diagnosis is usually delayed by 6 years, even though the symptoms are similar. This delay can make Late-onset IBD more difficult to treat since early treatment can prevent complications. Despite uncertainty about whether early and late onset IBD are different differ in location and how they behave, there's evidence that late-onset IBD might be more aggressive or poorly treated.
Treating Late-onset IBD
Some of the treatment options are the same as they are for younger patients, while some depend more age dependent. The treatment for mild UC is 5-ASA (known as mesalamine) <<mesalamine>> for both younger and older populations. On the other hand, immunomodulators <<immunomodulators>>(treatments that change the immune response in the body and help balance it) are not used as much in older patients, because of a higher risk of infections and a higher risk of cancer, especially if the patient has had cancer before. And steroids <<steroids>> are avoided unless necessary, because older adults risk eye disease like glaucoma and cataracts, fractures, and the chance of making conditions like diabetes and high blood pressure worse. Similarly, Anti-TNFs <<anti-TNFs>> (a treatment that helps treat systemic inflammation) are used more in younger populations because of the greater risks of severe infections in older patients. One study found that anti-TNF and immunomodulator therapy were associated with an increased risk of infection; the most common infection found in older IBD patients was pneumonia.
Surgery is often need more in Late-onset IBD
Surgery <<surgery for Crohn's disease>> is needed more often in late-onset Crohnies (Crohn's patients) because of their complicated disease. About 25% of all intestinal surgeries related to IBD are done on patients over the age of 55. They are also at a much higher risk for problems. Older Crohnies stay in the hospital twice as long their odds of surgical complications are 47% compared to 20% in younger patients. Much of the same is true for older UCees (those with UC). Surgery is needed more often, though there is again greater risk. In part, that's because of having other medical conditions at the same time. So it's important that when possible, any preexisting conditions are well managed before surgery is performed they have at the time.
- Ananthakrishnan AN and others. Management of Inflammatory Bowel Disease in the Elderly Patient: Challenges and Opportunities. Inflamm Bowel Dis. 2017; pages 882-93.
- Arnott I and others. The Management of Inflammatory Bowel Disease in Elderly: Current Evidence and Future Perspectives. Inflamm Intest Dis. 2018; pages 189-99.
- Dorreen A, and others. Treatment of Inflammatory Bowel Disease in the Older Patient. Inflamm Bowel Dis. 2018; pages 155-1166.
- Khan N and others. Risk of Infection and Types of Infection Among Elderly Patients With Inflammatory Bowel Disease: A Retrospective Database Analysis. Inflamm Bowel Dis. 2020; pages 462-8.
- Kochar B and others. Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset. Inflamm Bowel Dis. 2017; pages:1187-94.
This article, as well as all others, was reviewed and edited by a member of our Medical Advisory Board.
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