Older IBD Patients More Likely to Need Surgery and Given Cortisone Treatments Than Younger Ones, Swedish Study Reports

Older IBD Patients More Likely to Need Surgery and Given Cortisone Treatments Than Younger Ones, Swedish Study Reports

Older adults, age 60 or older, with inflammatory bowel disease (IBD) in Sweden are often treated with cortisone medications instead of newer, immune system-targeting therapies, and they are likely to have more severe disease than previously thought, researchers at the Karolinska Institutet report.

Their study “Incidence and Treatment of Patients Diagnosed With Inflammatory Bowel Diseases at 60 Years or Older in Sweden”, was published in the journal Gastroenterology.

IBD’s onset is usually between 20 and 30 years old, and studies suggest that in rare cases when it appears older adults it usually is less severe .

“We therefore sought to ascertain the incidence of inflammatory bowel disease in older age groups and if there is any difference in how they are treated and how they use the healthcare services,” Åsa Hallqvist Everhov, a researcher at institutet’s Department of Clinical Science and Education, and colorectal surgeon at Stockholm South General (Söder) Hospital, said in a press release.

The team analyzed data from 27,834 people newly diagnosed with IBD between 2006 and 2014, then divided them21 into three groups depending on their age at disease onset: childhood (younger than 18), adult (18-59) and older adult (60 or older). About one-fifth (23 percent or 6,443 of these patients) were in the oldest age group.

Patient data was obtained from the National Board of Health and Welfare’s patients and registers for prescribed drugs, and all had been followed for a median of 4.2 years.

Their healthcare use was compared to matched controls in the general population, without IBD.

Results showed that those in the oldest age group made lesser use of IBD-specific outpatient care than other adult patients, but had more “IBD-related hospitalizations and overall health care use,” the researchers wrote.  They were more likely to undergo bowel surgery within five years of an IBD diagnosis than younger patients (13 percent versus 10 percent, respectively), suggesting that the disease can be serious in this patient group.

“It’s common … for the disease to onset after the age of 60 and we found no evidence that when it does, the disease progress is milder,”  Everhov said.

Findings also revealed a difference in the choice of treatment between younger and more elderly patients. Specifically, those under age 60 were often prescribed immune system-targeting therapies, while those older were more often given cortisone treatments.

“We don’t know the reason for this, but it could be due either to under-prescription to older sufferers or to prudent choice, since the newer drugs carry certain risks and side-effects,” he said.

As a follow-up study, the researchers intend to examine the causes of the observed treatment discrepancies.