Inflammatory bowel diseases (IBD), which mainly include Crohn’s disease (CD) and ulcerative colitis (UC), represent a group of chronic conditions that cause inflammation in the gastrointestinal tract. Traditionally considered diseases of younger individuals, IBD is increasingly diagnosed in elderly patients, a trend that reflects both the ageing of the world population and advances in medical diagnosis.
In the elderly population, addressing IBD presents unique challenges. The clinical presentation may be atypical and less intense in terms of classic gastrointestinal symptoms but is often accompanied by systemic manifestations that complicate diagnosis and treatment. Furthermore, the coexistence of other chronic diseases and the greater susceptibility to side effects of intensive treatments require a careful and adapted approach.
The clinical aspects and symptoms of inflammatory bowel diseases (IBD) in patients ageing with the condition can vary significantly when compared with those diagnosed in adulthood or older age.
- Variable activity: Patients may experience prolonged periods of remission, interspersed with outbreaks of disease activity. The pattern of disease activity can change over time, requiring frequent adaptations to the treatment plan.
- Late complications: It is common to develop complications related to long-term disease, such as strictures (narrowing of the intestine), fistulas (abnormal channels between the intestine and other structures), and abscesses.
Atypical presentation:
- Less intense symptoms: Abdominal pain and other gastrointestinal symptoms may be less pronounced or vaguer compared to younger individuals.
- Systemic symptoms: Fever, fatigue, and weight loss may be more evident and significantly impact quality of life.
Impact of comorbidities:
- Interference with IBD symptoms: Comorbidities such as diabetes, cardiovascular disease, and arthritis can mask or complicate the management of IBD symptoms, making diagnosis and treatment of flare-ups difficult.
Common symptoms in the ageing population with IBD:
- Chronic diarrhoea: May be intermittent and vary in severity, sometimes containing blood if the inflammation is severe.
- Abdominal pain: Generally less intense than in younger patients, but still present and may be an indicator of complications.
- Involuntary weight loss: Often seen due to malabsorption of nutrients or reduced food intake due to gastrointestinal symptoms.
- Fatigue: One of the most debilitating symptoms, affecting an individual’s ability to carry out daily activities.
- Nutritional deficiencies: Common due to malabsorption and may require supplementation or specific dietary adjustments.
- Dehydration: Increased risk due to frequent diarrhoea.
The choice of treatment for elderly people with inflammatory bowel diseases (IBD) must be carefully considered, taking into account the particularities of this age group, which include a higher prevalence of comorbidities, polypharmacy, and greater susceptibility to side effects. The goal is to control inflammation, maintain disease remission, and minimise the risks associated with treatment.
In cases of IBD, especially Crohn’s disease, nutritional therapy can help control inflammation and correct nutritional deficiencies. In the elderly, this can be crucial to improving general health.
Before initiating treatment, a comprehensive geriatric assessment can help personalise the treatment plan while considering the elderly patient’s overall health needs.
Optimal treatment often involves a multidisciplinary team, including gastroenterologists, geriatricians, pharmacists, and nutritionists, to offer comprehensive and personalised care.
Article submitted by the HPA Group
