The management of inflammatory bowel disease in older adults

The rising incidence and prevalence of inflammatory bowel diseases (IBD) is increasing. Taken together with population ageing, the number of older adults with IBD globally is set to increase. The wide differential diagnosis of IBD in older adults may result in diagnostic delay. In addition, there is a higher prevalence of frailty among older people with IBD, which is recognisable across age groups. Despite some common features, there are important differences in the clinical presentation and natural history of older-onset IBD compared with those diagnosed at a younger age. Challenges posed by co-morbidity, polypharmacy and loco-motor dysfunction influence treatment considerations and require a holistic and often multi-disciplinary therapeutic approach. The typical exclusion of older persons from clinical trials of IBD therapies may negatively influence application of modern treatment paradigms in these individuals. Recognition of the potential disconnect between chronological and biological age, with careful dynamic risk-stratification including frailty assessment, must underpin pragmatic and when possible, evidence-based decisions in this potentially vulnerable group, taking care to avoid under-treatment. This review covers the clinical presentation, diagnostic considerations and complexities surrounding the holistic management of IBD in older patients.