Effects of Age on Inflammatory Bowel Disease Presentation and Management in Older Adults.

BACKGROUND: Inflammatory bowel disease (IBD) is facing a demographic shift with a growing number of older adults.Advanced age affects treatment patterns and as a result older IBD patients often face conservative treatment regimens. Complications associated with aging such as frailty, comorbidities, and polypharmacy pose challenges in management. AIM: This review critically examines the influence of aging on IBD presentation and evaluates evolving treatment frameworks in older adults. It further explores the interplay of key age-related factors and their combined impact on therapeutic decision-making, clinical outcomes, and treatment-related adverse events. METHODS: Studies for this narrative review were collected from Pubmed, Embase, and Web of Science. Studies addressing IBD presentation, disease outcomes, and treatment patterns in older versus younger adults were considered. Additionally, studies investigating age-related factors such as, frailty, comorbidity, and polypharmacy on treatment tolerance were considered. RESULTS: Disease activity and disease-related complications do not wane in severity with advanced age. Older IBD patients face overutilization of corticosteroids and reduced use of advanced therapies despite emerging data showing that certain advanced therapies such as, vedolizumab and ustekinumab, are well tolerated in this age group. Advanced therapies are often deferred due to age. However, our review highlights that frailty, comorbidity, and polypharmacy better predict treatment tolerability than chronologic age. CONCLUSION: IBD management should shift from age-based assumptions to risk-stratified care. Our review found thatage alone did not increase most adverse events related to advanced therapy usage. This calls for a paradigm shift in treatment approaches for older adults with IBD.