Older Adults with Celiac Disease Are At Increased Risk of Frailty:A Nationwide Cohort Study.

Background and aims: Celiac disease (CeD) is increasingly diagnosed in older adults, though few studies have explored complications in this group. As frailty confers increased risk for adverse events, we aimed to explore frailty in older adults with CeD.

Methods: In a nationwide Swedish cohort, we identified adults ≥60 years with incident CeD between 2004-2017 which we matched to population-based controls without CeD by age, sex, county, and calendar-period. Baseline frailty within 3 years before CeD diagnosis or index date was assessed using the Hospital Frailty Risk Score. Among those without baseline frailty, we used conditional logistic regression to estimate odds ratios and 95% confidence intervals (CI) of future frailty at 5 years comparing CeD to controls. Logistic regression was used to evaluate the association between persistent villous atrophy vs mucosal healing and frailty in CeD patients.

Results: A total of 4,646 older adults with CeD were matched to 21,944 non-CeD individuals. Baseline frailty was increased in CeD patients (54.4%) compared to controls (29.7%, p<0.001), which existed across all frailty categories: low-risk (43.4% vs 23.8%), intermediate-risk (10.3% 5.4%), and high-risk (0.8% vs 0.6%). Among those without baseline frailty, CeD patients had a 66% increased risk of overall frailty at 5 years (95% CI 1.50-1.83). Mucosal healing in CeD individuals on follow-up biopsy did not protect against future frailty.

Conclusions: Older adults with CeD were significantly more likely to become frail than matched comparators. This analysis reveals the increased vulnerability that older patients with CeD are likely to experience.