Inflammatory Bowel Disease in Older Adults: Modern Challenges, Solutions, and Hope

 This article summarizes the most important and up-to-date information about inflammatory bowel disease (IBD) in older adult patients, based entirely on the systematic review “Therapeutic Needs of Older Adults with Inflammatory Bowel Disease (IBD): A Systematic Review,” published in 2024 in Gastroenterology Insights (Davis et al., 2024).

The authors of this comprehensive analysis—Suja P. Davis, Rachel McInerney, Stephanie Fisher, and Bethany Lynn Davis—are healthcare specialists and researchers from the School of Nursing at the University of North Carolina at Chapel Hill, USA. By reviewing 42 scientific publications from recent years, they provide a synthesized understanding of diagnosis, treatment, quality of life, and the specific care needs of people over 60 living with IBD. The following questions and answers are formulated to be as helpful as possible for patients and their loved ones—illustrating the real-life dilemmas faced by people in this situation.

“Older adults with IBD face unique medical and psychosocial challenges that require an individualized and multidisciplinary approach.”

Expert Insights 

Inflammatory bowel diseases (IBD), such as Crohn’s disease and ulcerative colitis, are increasingly common among older adults. In this age group, the condition presents specific challenges when it comes to diagnosis, treatment, quality of life, and mental health. The 2024 systematic review published in Gastroenterology Insights brings together the latest findings and expert perspectives that can guide patients and caregivers toward safer, more informed choices in managing IBD in later life. Below are five key expert takeaways, each accompanied by clarifying questions and commentary to help highlight the most critical aspects of modern IBD care for older adults.

1. How effective and safe is biologic therapy in older adults with IBD?

“The infection risk was comparable between two groups [anti-TNF and Vedolizumab] within 1-year of beginning of the therapy. Infusion reaction and infection (20%) were the number one reasons for stopping anti-TNF therapy, whereas infection (14%) was the sole reason for stopping Vedolizumab. ... 3% patients from anti-TNF group and 1% from VDZ group developed a new onset of cancer excluding skin cancer or recurrence of their previous cancer after initiating the therapy.”

Explanation: Biologic therapies in older patients with IBD—such as anti-TNF agents and Vedolizumab—carry a similar risk of infections. However, side effects like infusion reactions and infections are among the leading causes of discontinuation. Although the risk of developing new cancers is relatively low, it remains real, particularly in patients with a previous history of cancer.

2. What are the distinctive features of IBD in older adults with Crohn’s disease or ulcerative colitis?

“No differences in disease location noted between elderly and adult onset UC. Non-structuring and non-penetrating behavior was the prominent one noted among both elderly and adult onset CD. ↓ rate of perianal disease (p = 0.018) and penetrating disease (p = 0.023) were noted among elderly onset CD.”

Explanation: In older adults, Crohn’s disease more often presents with colonic involvement and fewer complications such as perianal disease or penetrating forms. This has implications for both treatment decisions and disease prognosis. Ulcerative colitis in older individuals shows no significant difference in location compared to younger patients.

3. How frequent and serious are surgical complications in older adults with IBD?

“Post-operative mortality (within 30 days) was higher for both elderly UC (p < 0.001) and CD (p < 0.001) patients compared to non-elderly patients. ... ↑ rates of infectious complications after surgery among older IBD patients: ↑ risk for wound dehiscence, ventilator dependence, pneumonia, shock and UTI (p < 0.001 for all)”

Explanation: Surgical treatment in older IBD patients carries a higher risk of mortality and infections compared to younger patients. These complications include lung and urinary tract infections, sepsis, and increased need for blood transfusions. As a result, surgery must be considered with great caution in this population.

4. What role does mental health play in older adults with IBD?

“22.6% (n = 81) had a score that matched with the diagnosis of major depression. ... Higher levels of disease activity was significantly associated with depression for older adults with both CD (p = 0.005) and UC (p = 0.003). Significant reduction in QOL (p < 0.001) and medication adherence (p = 0.01) noted among depressed older adults with IBD.”

Explanation: Depression is a common co-occurring issue in older adults with IBD. It is linked to reduced quality of life, lower medication adherence, and higher disease activity. This underscores the need for mental health to be an integral part of comprehensive care for these patients.

5. What are the challenges related to multiple chronic conditions and the need for multidisciplinary care?

“51.6% of patients have geriatric deficits in somatic domain (comorbidity, polypharmacy, and nutrition) ... ↓ HRQOL noted with positive of biochemical and clinical disease activity and geriatric deficits. Individuals with elderly onset IBD were found to have more impairment in the mental domain, primarily as a cognitive impairment (16.9% vs. 6.7%; p < 0.001)”

Explanation: More than half of older IBD patients suffer from additional chronic conditions and are often prescribed multiple medications, complicating their treatment. The high rate of cognitive impairments and nutritional deficits highlights the need for a multidisciplinary approach—including involvement of a gastroenterologist, psychiatrist, dietitian, and pharmacist.

Questions and Answers

1. How does IBD in older adults differ from IBD in younger patients? 

Answer: According to the systematic review, older adults with IBD more frequently present with a colonic form of Crohn’s disease, and the disease is less prone to complications like penetrating or perianal involvement compared to younger patients. Additionally, while ulcerative colitis symptoms are generally similar across age groups, older adults tend to report fewer symptoms such as abdominal pain or rectal bleeding.

2. Will my medication needs differ, and what are the treatment trends for older adults with IBD? 

Answer: Older IBD patients are less frequently prescribed biologics or immunosuppressants and more often treated with corticosteroids and 5-ASA drugs. In some countries, like Canada and Denmark, there is a higher use of topical (rectal) treatments. Still, there is a growing trend toward prescribing biologics. However, older adults are more likely to experience side effects or reduced efficacy, which often leads to discontinuation of therapy.

3. Am I at increased risk for other illnesses or complications as an older adult with IBD? 

Answer: Yes, older adults with IBD commonly have multiple chronic conditions—such as heart disease, lung disorders, and diabetes. Nutritional deficiencies, including low levels of iron, vitamin B12, and vitamin D, are also more frequent. This requires regular monitoring and coordinated, multidisciplinary care.

4. What should I expect in terms of hospital stays and interaction with the healthcare system? 

Answer: Older IBD patients tend to be hospitalized more frequently, especially within the first year after diagnosis. Hospital stays are generally longer and more costly. Despite this, they are less likely to see a gastroenterologist or receive endoscopies compared to younger patients. Emergency care or urgent consultations are more often needed due to complications.

5. What factors can improve my care and outcomes as an older adult with IBD? 

Answer: Having a gastroenterologist involved in your care significantly reduces the risk of hospitalization and surgery and increases the chances of receiving modern treatments (like biologic drugs). Patients managed only by primary care providers are more likely to be prescribed immunosuppressants and face higher risks of complications. Additionally, mental health care, dietary management, and routine follow-ups are key to maintaining a good quality of life.

Conclusion 

The perspective on IBD in older patients presented in the systematic review by Davis and colleagues reveals a complex medical and social challenge that demands an integrated, individualized, and multidisciplinary approach. Despite advances in modern medicine, older adults with IBD remain a vulnerable group—not only due to the risks of complications and coexisting conditions but also because of barriers to appropriate care and support. The hope is that the evidence summarized here will help patients, families, and healthcare providers make more informed decisions, recognize the risks, and advocate for comprehensive, up-to-date care.

Reference: Davis, S.P.; McInerney, R.; Fisher, S.; Davis, B.L. “Therapeutic Needs of Older Adults with Inflammatory Bowel Disease (IBD): A Systematic Review.” Gastroenterol. Insights 2024, 15, 835–864. https://doi.org/10.3390/gastroent15030059