Medical and Surgical Complications of Inflammatory Bowel Disease in the Elderly: A Systematic Review

Shung, Dennis; Abraham, Bincy; Sellin, Joseph H.; Hou, Jason K.

doi:10.1007/s10620-014-3462-2

Cited by 22 publications

(21 citation statements)

References 45 publications

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“…9, 19 However, reports that note a higher rate of complications in older patients who are treated with immunosuppression also note that there is a paucity of high quality data evaluating treatment-related outcomes in older IBD patients. 7-9, 18, 21 A more recent study reported lower rates of non-infectious complications and a similar rate of infectious complications in elderly-onset CD patients compared to young controls. 9 It is also possible that co-morbidities and polypharmacy may limit the use of biological agents in older adults.…”

Section: Discussionmentioning

confidence: 96%

“…We require a thorough understanding of how the disease process differs in older adults in order to best balance co-morbidities, polypharmacy and use of resources in treating older patients with IBD 6 . Prior reports of IBD in older adults have often focused on those who are newly-diagnosed at an older age; less is known about how IBD evolves with age as patients with IBD survive longer 5, 7-11 . There is also a need to understand how IBD differs between those who age with the disease and those who are newly diagnosed at an older age.…”

Section: Introductionmentioning

confidence: 99%

“…The first practical treatment guidelines for IBD in the elderly were published in 1997 12 . Numerous studies note that corticosteroids are not optimal first line agents for treatment of IBD in older adults 7, 12, 13 . However, recent studies reveal that corticosteroids are widely used for maintenance in elderly patients with IBD 14-17 .…”

Section: Introductionmentioning

confidence: 99%

“…However, recent studies reveal that corticosteroids are widely used for maintenance in elderly patients with IBD 14-17 . Other studies recommend against using a combination of immunosuppressive agents in older individuals due to an increased risk of infectious and neoplastic complications 7, 9, 15, 18-20 . However, this greater risk of infectious or neoplastic complications in older patients with IBD has not been well established in the literature 21 .…”

Section: Introductionmentioning

confidence: 99%

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Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Kochar

Long

Galanko

et al. 2017

Inflammatory Bowel Diseases

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Background As the American population is aging, the number of older people with IBD is increasing. We used clinical data from the Sinai-Helmsley Alliance for Research Excellence (SHARE), a prospective cohort, to examine disease and treatment differences in older adults. Methods We performed a cross-sectional study assessing demographics and disease behavior by age at diagnosis with univariate, bivariate and multivariate analyses. “Older-onset” patients were diagnosed after age 60, “younger-onset” patients were diagnosed before age 60, but are older than 60 years and the remainder were “young”. Results There were 91 older-onset, 389 younger-onset and 3431 young Crohn's disease (CD) patients. Older-onset patients had more ileal (37%) and colonic (27%) disease compared to younger-onset and young patients. There were no differences in disease behavior, location or surgeries between older-onset and young CD patients within 5 years of diagnosis. Older-onset patients with inflammatory disease had a higher odds of being in remission. Young patients reported more anti-TNF and thiopurine use compared to younger-onset and older-onset patients (p <0.01). There were 98 older-onset, 218 younger-onset and 1702 young ulcerative colitis (UC) patients. There were no differences in disease extent, activity index or surgeries. Young UC patients reported more anti-TNF use (26%) compared to younger-onset patients (17%, p <0.01). Conclusions Disease behavior or location were not different between younger and older adults with IBD. Older patients were less likely to be treated with immunosuppression. If older patients have similar disease behavior, less frequent treatment with immunosuppressives may risk sub-optimally controlled disease.

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Kochar

Long

Galanko

et al. 2017

Inflammatory Bowel Diseases

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“…Data suggests no difference in patient need for surgical resection based upon age at presentation, and no difference in rates of surgery for hospitalized IBD patients [ 57 ]. As such, surgical management of IBD is safe for elderly patients and should be considered in select individuals but not in the absence of serious thought for the risk of fecal incontinence and decline in quality of life.…”

Section: Infl Ammatory Bowel Diseasementioning

confidence: 99%

Considerations for Geriatric Patients Undergoing Colorectal Surgery

Kasten

Francone

2016

The ASCRS Textbook of Colon and Rectal Surgery

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Key Concepts• The geriatric population is diverse, with varying levels of health status including physiologic reserve and cognitive function. As such, chronological age is a poor marker of functional, physical, and cognitive decline in the elderly.• Fit elderly patients, those without signifi cant comorbidities or cognitive decline, can be managed similar to that of younger patients. Frail patients are associated with higher morbidity and mortality in both elective and emergent operations.• Elderly patients undergoing emergent procedures are at high risk (17-31 %) for post-operative mortality.• Minimally invasive surgery is safe and appropriate in the elderly population, allowing them to benefi t from decreased post-operative morbidity, faster return of bowel function, decreased length of stay, and less pain.• While some assessment models identify age as an independent risk factor for adverse outcomes, a focus on chronologic age substantially limits effective management of the geriatric patient.• Frailty is used to represent a global limited reserve in the elder population. As such, abnormalities in frailty domains are a potentially useful tool for predicting poor outcomes.

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Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review

Ramage

Qiu

Georgiou

et al. 2016

Int J Colorectal Dis

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AimIleal pouch-anal anastomosis (IPAA) is performed in ulcerative colitis or familial adenomatous polyposis with a view to restoration of GI continuity and prevention of permanent faecal diversion. Debate exists as to its safety in older patients. This review aims to assess functional outcomes and safety of restorative proctocolectomy (RPC) in older compared to younger patients.MethodsLiterature search was performed for age-stratified studies which assessed functional outcomes of IPAA. Twelve papers were included overall. Patients were categorized into ‘older’ and ‘younger’ groups. Analysis was split into three separate parts: 1. Age cut-off of 50 ± 5 years (with sensitivity analysis); 2. Age cut-off of 65 ± years; 3. Long-term outcomes (>10 years).ResultsWith an age cut-off of 50 years (4327 versus 513 patients), complication rates were comparable with the exception of an increased rate of small-bowel obstruction in the younger patients (p = 0.034). At 1 year, 24-h stool frequency was significantly higher in the older patient group (p < 0.0001). Daytime (p < 0.0001) and night-time (p < 0.0001) incontinence rates were also significantly higher in older patients.Overall, function deteriorated with time across all ages; however, after 10 years, there was no significant difference in incontinence rates between age groups.Dehydration and electrolyte loss was a significant problem in patients over 65 (p < 0.0001).Despite differences in postoperative function, quality of life was comparable between groups; however, only a few studies reported quality of life data.ConclusionIPAA is safe in older patients, although treating clinicians should bear in mind the increased risk of dehydration. Postoperative function is worse in older patients, but seems to level out with time and does not appear to significantly impact on overall quality of life and patient satisfaction. Assessment for suitability for RPC should not be based on chronological age in isolation. It is imperative that the correct support is given to older patients with worsened postoperative function in order to maintain patient satisfaction and adequate quality of life.

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Medical and Surgical Complications of Inflammatory Bowel Disease in the Elderly: A Systematic Review

Cited by 22 publications

References 45 publications

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Inflammatory Bowel Disease is Similar in Patients with Older Onset and Younger Onset

Considerations for Geriatric Patients Undergoing Colorectal Surgery

Functional outcomes following ileal pouch-anal anastomosis (IPAA) in older patients: a systematic review

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