[00:30]
Hello, I’m Dr. Adam Faye, and welcome to IBDIQ, part of The IBD Project by Takeda, where we’re coming together to help enhance expertise in IBD care—right from the start.
I'm delighted today to speak to you on the topic of diagnosing older adults with inflammatory bowel disease (or IBD). In this presentation, we will review the increasing prevalence of IBD in older adults and diagnostic considerations and clinical presentation specific to this population.
[01:02]
To begin, let’s talk about what “older” means. It is important to note that there is no consensus on the definition of “older.”1 In my practice, I define it as patients over the age of 60, but these definitions can vary between studies, from patients over the age of 60 to patients over the age of 75.
The U.S. population is aging. From this visual you will see the National Population Projections for the United States incorporating the most recent Census results.2 In 2022, 17% of individuals were over the age of 65 years, projected to increase to 21% by 2030. Fast forward to 2100, and this demographic will represent 29% of individuals.
[01:52]
This change in the demographic parallels the increase in patients over the age of 65 newly diagnosed with IBD. Research from the 2019 Global Burden of Disease Study indicated that approximately 16% of men and 17% of women newly diagnosed with IBD in the Americas were at least 65 years old.3 This, plus the aging of individuals who were diagnosed with IBD at a younger age, comprise the growing population of older adults with IBD.1
A 2022 study by Agrawal and others evaluated the incidence and prevalence of IBD over time by reviewing registry data from Denmark of nearly 48,000 people with an IBD diagnosis between 1995 to 2016.4
[02:44]
The study showed that the prevalence of Crohn’s disease (or CD) and ulcerative colitis (or UC) is increasing.4
When we look at the age breakdown of patients in the registry, the prevalence of CD over time has increased in patients aged 65 years and older, as well as in other age groups.4
We can observe a similar pattern in the increased age-specific prevalence of UC over time.4
Overall, these data demonstrate a median age increase of approximately 6 to 7 years, which can be seen when examining the age distribution of patients with Crohn’s disease or UC from 1995 to 2016.4 This pattern is similar to what we’re seeing in my practice as well.
[03:31]
Now that we understand that the population of older adults with IBD is growing, let's turn our attention to diagnostic considerations for IBD in the older adult.
New-onset IBD in older adults can be a diagnostic challenge, as these patients often have more comorbidities or are taking more medications.5-7 Additionally, diagnosis can be complicated by atypical presentations and the physical changes associated with aging.5 Symptoms can also be more subtle in older adults.
[04:04]
Other conditions more common in older adults may mimic IBD, so differential diagnosis is important.5 We have to make sure that patients don't have infectious colitis or that they're not experiencing nonsteroidal anti-inflammatory drug (or NSAID)-induced enterocolitis. Also, certain IBD mimics are more common in older adults such as ischemic colitis, segmental colitis associated with diverticula, and radiation colitis. This table highlights some of these IBD mimics and their corresponding differentiating findings.
It’s important to confirm the diagnosis of IBD through accurate patient history and the use of laboratory investigations, stool testing, cross-sectional imaging, and colonoscopy with histologic confirmation as management of IBD and conditions that mimic IBD varies greatly.8
[05:03]
When seeing an older adult with new-onset gastrointestinal (or GI) symptoms, it's important to note that there's a difference in IBD phenotypes based on age at onset.8
A retrospective, observational, case-control study published in 2018, conducted across multiple centers in Spain, compared 1,374 individuals who developed IBD at age 60 years or older to those who developed it between the ages of 18 to 40 years.9
As you can see from the study data, a much larger proportion of individuals with older-onset UC had left-sided colitis, and a lower prevalence of proctitis and pancolitis compared to those with younger-onset UC.9,10
[05:52]
What about Crohn’s? Compared to the younger cohort, a greater proportion of older patients had ileal disease or colonic disease individually, but a much lower proportion had both ileal and colonic disease, and the 2 cohorts had a similar proportion of upper gastrointestinal disease. The proportion of patients with perianal disease was slightly lower in older adults.9,10
Within the Crohn’s phenotype, a similar amount of older and younger individuals had an inflammatory phenotype, but older adults tended to have more stricturing disease and less penetrating disease.9,10
I hope what we just discussed gave you a deeper understanding of the increasing prevalence of older adults with IBD and some diagnostic considerations. Check out my other IBDIQ video where I present additional education on therapeutic management considerations and health maintenance for IBD to provide ongoing care for our older adult patients.
[06:56]
Let’s review what we’ve discussed today. With the increase in older adults with IBD, it’s important to have the tools to be able to improve outcomes in this demographic.1,3,4
When diagnosing older patients with IBD, consider the patient’s comorbidities and physical changes that may come with age.5,7
It is also important to acknowledge that there can be differences in disease phenotype depending on the patient’s age at onset.8
Thank you for your interest and for spending some time with IBDIQ today to help adapt to the evolving care needs of all patients with IBD.
