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Journal Article
Clinical implications of ageing for the management of IBD
2014
Overview
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
Factors associated with ageing, such as comorbidities, polypharmacy and diminished physical reserve, can affect the natural history of IBD. 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.
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.
Publisher
Nature Publishing Group UK,Nature Publishing Group
Subject
