Relationship between IBD and aging

Inflammatory bowel disease (IBD) has long been considered a middle-aged and even younger illness. Chronic diseases such as Crohn’s disease and ulcerative colitis can cause abdominal pain, diarrhea, bleeding, and poor quality of life, affecting approximately 3.1 million people in the United States. -Aging. According to 2021, more than a quarter of IBD patients are elderly and are projected to rise to 30% by 2030. Gastroenterology and hepatology article.

Even more underestimated is the increasing number of people diagnosed with the disease after the age of 60. IBD was once taught as a disease with two spikes, one in the 20s and 30s and the other in the 40s and 50s, but doctors are learning that there is one-third. Spikes that begin later in life. “We now know that we can develop IBD at the age of 75,” said Dr. Simon Hong, a gastroenterologist and IBD specialist at NYU Langone Health.

But no matter when the illness begins, we understand and treat it.Elderly IBD It comes with its own challenges and complexity.

IBD looks different in the elderly

Hundreds of thousands of people diagnosed with IBD early in life are now older and living with the disease. For many, it means living with the damage that the illness has caused to the intestinal tract, sometimes with the changing effects of surgery performed to manage it, such as ostomy pouches and increased incontinence. Not to mention the continuous relapse.

It was generally thought that illness activity gradually diminished in old age, but some people find that their IBD becomes inactive in later years. But that’s not always the case, says Dr. Jessica Philpot, a gastroenterologist at Cleveland Clinic. “I certainly see some patients who develop more progressive illnesses as they get older,” she says.

For people who develop IBD after the age of 60, the disease can look a little different than people who have had it for decades. Patients with young Crohn’s disease can damage any part of the intestinal tract, but older cases often affect the colon primarily.

As people grow older, it becomes more difficult to diagnose new cases of IBD. There are many more common reasons that older people may experience, such as bloody diarrhea. This alarming symptom is one of the first reasons for IBD assessment in young people. However, for people in their 60s and older, doctors may develop many other conditions, such as infections, colonic ischemia, other forms of colitis, diverticulitis, and cancer, before investigating IBD as a potential cause. Must be excluded.

And older people often already face more health problems, so they may not seek medical assistance right away. Crohn’s disease, in particular, can be more difficult to identify than ulcerative colitis. This is because it can manifest as intermittent abdominal pain and weight loss. This is not uncommon in the elderly in general. These factors can delay proper diagnosis and delay effective treatment for years.

Dr. Gil Melmed, director of clinical research on inflammatory bowel disease at the Cedars-Sinai Medical Center in Los Angeles, tells the story of a patient who is now 84 years old. She had been hospitalized many times because of abdominal pain and bloody diarrhea. Her doctor repeatedly diagnosed her as her diverticulitis and treated her with antibiotics. Her symptoms improve for a while and then come back.Then she caused additional complications, including those where antibiotics are dangerous That’s hard infection. When Melmed first met her, after yet another hospitalization, he realized she wasn’t suffering from diverticulitis other than Crohn’s disease at all.

Hong has seen this misdiagnosis cycle countless times. “Doctors always remember to list IBD,” he says.

The rate at which people develop late-onset IBD appears to be increasing, probably due to environmental triggers such as air pollution, making vigilance even more important.

Inflammation, menopause, and other complications

At its core, IBD is a disease of chronic inflammation.Aging itself is also associated with increased inflammation, and this association gives rise to this term. inflammation. Therefore, elderly patients with IBD have cardiovascular disease, cancer, etc. obesitySkin problems, arthritisAnd loss of skeletal muscle.

Experts warn that some common health complaints may resemble those of older people without IBD, but in reality IBD is causing another problem. For example, joint pain in an elderly patient may initially look like osteoarthritis, but with IBD, it can be a completely different form of arthritis.

Older IBD patients are also at increased risk of other symptoms such as osteoporosis, colon cancer, skin cancer, blood clots, and general deconditioning.

A long list of potential health problems enhances the importance of standard preventive care, including good nutrition and exercise, as well as simple ones like regular immunity, Melmed said. Until recently, many vaccines for the elderly contained live viruses, so it was dangerous to mix them with some IBD therapies. This is no longer the case, and in fact, because so many IBD treatments suppress the immune system and aging itself is associated with an increased risk of infection, these patients regularly respond to: Vaccination is especially important. pneumonia.

As the aged body is affected by IBD, there are still many unclear points about its complexity. The reverse is also true. For example, it is not yet well understood how IBD aging differs between postmenopausal and postmenopausal women, and what role menopausal treatment may play in the course of the disease. Although some small studies have found a modest protective role for estrogen replacement therapy for IBD disease activity, the answer is not yet definitive. “We really need more data in this area,” said Dr. Sunanda Kane, who specializes in IBD and women’s health at the Mayo Clinic in Rochester, Minnesota.

However, if doctors are over-focused on the patient’s IBD and its treatment, even as large as menopause can be overlooked or misunderstood. Kane recalls a 57-year-old patient receiving new monoclonal antibody therapy for ulcerative colitis. One day, the patient told his doctor that he had “fever” and “confusion.” Her doctor concluded that she was likely suffering from a rare brain infection as a result of IBD medication, told her to discontinue her medication, and referred her to her neurologist. .. While the patient was anxiously waiting for a neurological appointment, she called Kane and she instead asked what other IBD medications she could take. Kane listened to her patient and she realized that her symptoms were menopausal. Kane reports that the patient was successful as she returned to her previous IBD treatment and estrogen replacement therapy. However, the presence of IBD has helped to remind us that, as is often the case during the aging process, it can cloud the patient’s overall picture assessment when major health changes occur.

One thing that has become clear as more people grow older with IBD is that when assessing patients for IBD and its treatment prospects, it is not just age. Experts are now advocating making decisions based on their vulnerability score for chronological age. And like inflammation, the combination of aging and IBD increases the likelihood of frailty, which puts someone at greater risk of deterioration of health.

Confusion about treating IBD in old age

As everyone grows older, the treatment of illness tends to be more difficult. There are more comorbidities, an extension of the list of medicines, and overall health of the person to consider. These factors are even more important when considering IBD therapy. “Everything we do, from procedure to treatment, is different for older people,” says Philpott of Cleveland Clinic.

As the disease progresses to a particular condition, doctors often turn to surgery to remove the damaged part of the intestinal tract. However, this is not always an option for very vulnerable patients with IBD, regardless of age.

Of course, the disease is usually well managed with medicine. However, there are some common pitfalls that warn experts dealing with older IBD patients.

One of the greatest concerns in drug treatment for older IBD patients is susceptibility to infections. This is because almost all IBD medicines somehow weaken the immune system and are already declining with age. However, according to experts, this concern can lead to significantly undertreatment of symptoms or even more dangerous forms of drug treatment.

For decades, corticosteroids have been IBD therapy.. And they are still indicated for short-term treatment of relapse of mild to moderate illness, especially in young adults. However, their long-term use, especially for the elderly, is less effective than other options and, in fact, increases the risk of hypertension, diabetes, bone loss, infections, osteoporosis, and overall mortality. There is a possibility.

Nevertheless, according to a 2015 study, about 30% of older IBD patients are prescribed steroids for more than 6 months at a time. Inflammatory bowel disease. Part of the reason, according to Hong of New York University, is that “they are considered a kind of” safe “option” because of the long history of these medicines. Instead, he states, “It’s much better to take one of the new biologics than to take steroids for a long time.”

Over the last few decades, small molecule “biopharmacy” has emerged as a newly established treatment for IBD. Drugs such as antitumor necrosis factor agents are particularly effective. However, some clinicians are reluctant to prescribe these drugs, especially in the elderly, as they are known to increase the risk of cancer such as lymphoma. Some doctors recommend surgery that poses a substantive risk to the elderly before trying biopharmacy.

An 84-year-old patient with Melmed who was finally diagnosed Crohn’s disease Research on biopharmaceuticals began immediately, but there is no relapse yet. Melmed acknowledges that these drugs are at risk for older patients. But he sees the big picture of “how to best benefit the patient,” he says. “There is no risk-free option. We certainly don’t want to deny the potential benefits of effective treatments to them just because someone is old.”

As part of that approach, Melmed advocates assessing not only the patient’s bowel health, but also the patient’s environment and well-being.

It is known that young people with IBD have a high incidence of depression due to the unpredictability of seizures and have major challenges in navigating normal life. And there’s no reason to think this is different for people just because they’re smart for years or decades. However, depression can be more difficult to detect in older patients if not screened, and it may be acceptable as usual to be quite home or lack of social support. I have. But it doesn’t have to be that way, experts agree.

“As doctors, we are always focused on inflammation,” says Hong of New York University. “But in reality, what matters is what this older patient wants to do. Do they want to travel or bike around the park?” And that’s the risks and benefits of treatment for specialists. Conversations about should be focused. “Just because they’re old doesn’t mean they don’t deserve the same quality of life,” says Hong. “Don’t settle down.”

inquiry so [email protected]..