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  • Review Article
  • Published:

Clinical implications of ageing for the management of IBD

Nature Reviews Gastroenterology & Hepatology volume 11, pages 128–138 (2014)Cite this article

Subjects

Key Points

  • Ageing is associated with immunodeficiency relative to younger people, which is termed 'inflamm-ageing' and might affect the natural history of IBD in the elderly

  • Pharmacokinetic changes associated with ageing might affect drug metabolism, dosing schedules and response to IBD therapies

  • Comorbidities, with associated polypharmacy, are prevalent among elderly patients with IBD and interactions between different medications can increase the likelihood of adverse effects

  • Thiopurines and anti-TNF agents are under prescribed among older patients with IBD, with a tendency towards sustained corticosteroid and mesalazine use, even among patients with moderate-to-severe disease or steroid dependency

  • The therapeutic efficacy of immunomodulators and biologic agents in older patients might not reflect the response rates reported in clinical trials, as adverse effect profiles can limit sustained use

  • Further investigation of the natural history and response to therapy within the older IBD cohort is essential, as the complexities associated with ageing might compete with optimizing IBD care

Abstract

As the global population ages, the number of older people (≥65 years) living with IBD is expected to increase. IBD therapeutics have advanced considerably over the past few decades with the introduction of multiple steroid-sparing agents as well as numerous clinical trials that have tested new therapeutic targets. However, the current paradigms for IBD management might not be directly translatable to older patients with IBD. Age-related factors such as immunodeficiency relative to younger patients, comorbidity, polypharmacy and diminished physical reserve directly or indirectly affect the natural history of their disease. This Review highlights how these age-associated variables can affect older patients with IBD and also illustrates the multiple gaps in our current knowledge of IBD in the elderly.

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Figure 1: The challenges in assessing treatment response and safety in older patients with IBD.
Figure 2: Age-associated changes in the function of B cells and T cells.

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Authors and Affiliations

  1. Division of Digestive Diseases, David Geffen School of Medicine at UCLA, 200 Medical Plaza, Suite 365C, Los Angeles, 90095, CA, USA

    Christina Y. Ha

  2. Division of Gastroenterology, NYU Langone Medical Center, 1000 Northern Boulevard, Great Neck, 11021, NY, USA

    Seymour Katz

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  1. Christina Y. Ha
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C. Y. Ha contributed to all aspects of the manuscript. S. Katz contributed to discussion of the manuscript and reviewed/edited the manuscript before submission.

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Correspondence to Christina Y. Ha.

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C. Y. Ha has developed and participated in continuing medical education programs sponsored by grants from Shire Inc. She has also participated in scientific advisory boards for UCB. S. Katz is on the speaker's bureau for Warner-Chilcott and UCB. He also receives grants/research support from Abbott, BMS, Centocor, Forest, GSK, Hutchison, Millennium, Pfizer, Prometheus, Quest, Shire and UCB.

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IBD medication monitoring for elderly IBD patients (DOC 49 kb)

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Ha, C., Katz, S. Clinical implications of ageing for the management of IBD. Nat Rev Gastroenterol Hepatol 11, 128–138 (2014). https://doi.org/10.1038/nrgastro.2013.241

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