The relationship between IBD and old age

Irritable bowel syndrome (IBD) is thought to be a disease of the middle, or young, young. Chronic obstructive pulmonary disease – associated with Crohn’s disease and ulcerative colitis, which can cause stomach, upset, bleeding, and decreased quality of life – is associated with to 3.1 million people in the U.S. But it’s far from a disease that’s just young and middle -aged – old age. More than a quarter of people with IBD are elderly, a number expected to rise to 30% by 2030, by 2021. Gastroenterology & Hepatology Article.

The growth of people diagnosed with the disease after the age of 60 is even less noticeable. Although IBD has been studied as a disease with two spikes in the octopus – 20s to 30s , and 40s and 50s – doctors teach there is a third. spike starting after life. “Now we know you can be 75 and have IBD,” Drs. Simon Hong is a gastroenterologist and IBD specialist at NYU Langone Health.

Even when the disease begins, however, understanding – and treating – IBD in the elderly can come with its own set of problems and difficulties.

The symptoms of IBD are different in the elderly

Hundreds of thousands of people diagnosed with IBD in their lifetime are living with the disease in old age. Many people live with the damage caused by the disease to their abdomen, and sometimes with the side effects of surgery performed to treat it, such as ostomy bags. Or increased incontinence. Not to mention continuity.

It is a common belief that the disease will stop in old age, and some people find that their IBD becomes insignificant later in life. But that’s not the case, says Cleveland Clinic gastroenterologist Dr. Jessica Philpott. “I really see some patients who develop serious illness as they go through the years,” he said.

For people who get IBD after the age of 60, the condition may be different than for those who have had it for ten years. While young Crohn’s patients can have damage to any part of their abdomen, in older cases — the colon is more likely to be affected.

As people age, it becomes more difficult to detect a new case of IBD. There are many common causes for an elderly person, for example, leukemia. This alarming condition is one of the primary causes of IBD diagnosis in a young person. But for someone in their 60s or older, doctors often have to rule out a host of other conditions – such as diarrhea, ischemia of the colon, forms of colitis, diverticulitis, and diverticulitis. cancer – before looking for IBD is a valid cause.

And because older people are more likely to have health problems, they are less likely to seek immediate medical attention. Crohn’s disease is more common than ulcerative colitis, because it can be presented as an upset stomach and weight loss, which is not uncommon in the elderly. These factors can delay proper certification, and thus maintenance, for years.

Dr. Gil Melmed, director of inflammatory bowel disease research at Cedars-Sinai Medical Center in Los Angeles, has a history of 84 patients. He has been admitted to the hospital several times. especially for stomach ache and blood clots. Doctors often diagnosed her with diverticulitis and treated her with antibiotics. Her symptoms will get better for a while and then come back. Then the antibiotics led to further complaints, with some complications C.sey disease. When Melmed first saw him, after he was admitted to the hospital, he knew he had not diverticulitis but Crohn’s disease.

Hong saw this wrong circle many times. “Doctors should always keep in mind that IBD is on their list” for the elderly, he said.

An increasing number of people with IBD after onset, perhaps due to environmental factors such as air pollution, need to be more vigilant. .

Inflammation, menopause, and other problems

At its core, IBD is a disease of the chronic neck. Old age is also associated with increased inflammation, a relationship that has led to the development of the word. to lighten. Therefore, elderly patients with IBD are more at risk for a number of inflammatory -related health consequences, such as cardiovascular disease, cancer, obesity, skin problems, arthritis, and weight loss. of the skeletal flesh.

Experts note that some common health problems may be similar to those in the elderly without IBD, but in fact IBD has begun to be a different problem. For example, an elderly patient may first be diagnosed with osteoarthritis, but if they have IBD, it may be a different form of neck pain.

Older IBD patients have also been diagnosed with other diseases such as osteoporosis, colon and skin cancer, hemorrhage, and physical deconditioning.

A long list of health problems can increase the importance of regular preventive care, including good nutrition and physical activity, as well as simple ones such as chronic illnesses, Melmed memo. To date, there are many medications for the elderly with chronic kidney disease, which are more risky when combined with other IBD medications. This is not the case, he says, and in fact, because many IBD drugs suppress the immune system – and old age is associated with a higher risk of disease – these diseases are very important. have common grains for the same purposes. pneumonia.

There is a lot of ignorance about the severity of the aging body as a result of IBD, and that is. For example, we don’t know much about the elderly with IBD as to how women go through menopause and beyond, and what is the role of menopause management in the future. disease course. A few small studies have found a low prognosis for estrogen-replacement drugs for IBD treatment, but the answers are unclear. “We need more information in this area,” said Drs. Sunanda Kane, a specialist in IBD and women’s health at the Mayo Clinic in Rochester, Minn.

But something as important as menopause can be lost – or misunderstood – when doctors pay close attention to a patient’s IBD and his or her medications. Kane recalls a 57 -year -old patient on a new form of monoclonal antibody therapy for his ulcerative colitis. One day the patient told her primary care physician that she was having “fevers” and “convulsions.” The doctor determined that he may have had a brain injury as a result of his IBD medication, told him to stop his medication, and referred him to a neurologist. While the patient was waiting anxiously for his neurology choice, he called Kane to ask about other IBD medications he could take. Kane listened to the patient’s story and realized that he had symptoms of menopause. After his initial IBD treatment and estrogen-replacement therapy, the patient was well, Kane reported. But it does serve as a reminder that the course of IBD can cover evaluations of the patient’s full picture, even as major health changes arise, as is often the case during pregnancy. old age.

One thing that is clear to many people living with IBD into old age is that when evaluating patients for IBD and their medications, it is not related to the condition. years old. Experts advocate determining the number of weak points of a person over a period of time. And like inflammation, the combination of old age and IBD increases the risk of weakness, which puts one at greater risk for adverse health consequences.

Confusion about the care of elderly IBD

As with any age, it is more difficult to manage the disease. There are more diseases, a long list of medications, and the overall health of a person to consider. These factors are even more important when considering IBD medications. “Everything we do, from procedures to care, is different because it’s so much more,” Cleveland Clinic’s Philpott said.

When the disease spreads to a certain state, doctors often look for an incision to remove the painful part of the abdomen. However this is not an option for the most vulnerable patients with IBD, no matter their age.

The disease, of course, can be effectively treated with medication. But there are some common pitfalls, teaching professionals to work with older IBD patients.

One of the main concerns of medications for older IBD patients is the possibility of developing the disease, because almost all IBD medications are in some way to suppress the immune system, and the age is decreasing. But this concern, experts say, could lead to more treatment of the condition – or treatment with better types of medications.

For many years, corticosteroids have continued in IBD therapy. And they are more likely to treat young people with short -term treatment. But their long -term use, especially for the elderly, is better than other options, and can lead to higher risk factors, such as hypertension, diabetes, bone loss, disease, etc. osteoporosis, and total death.

However, about 30% of older IBD patients are prescribed steroids for six months at a time, according to a 2015 study in Stinging diseases. Part of the reason, says NYU’s Hong, is that because of the long history of these drugs, “they are seen as a form of ‘safe’ choice.” But, he says, “I would argue that instead of taking steroids for long periods of time, it would be better than any of the newer supplements.”

In the last decade, small molecules “biologics” have entered the field as a new treatment for IBD. Medications such as antitumor necrosis factor agents are more effective. Some doctors are reluctant to prescribe these medications, however, because they have been shown to increase the risk of cancer, such as lymphoma, more in the elderly. Some doctors recommend discontinuation – which comes with its own risks for the elderly – rather than experimenting with biologics.

Melmed’s 84 -year -old patient was diagnosed with Crohn’s disease who was immediately diagnosed with biologics, but never recovered. Melmed notes there are problems with these medications for the elderly. But he’s looking at the bigger picture of “how to best heal the patient,” he said. “It’s not a risk -free choice. Because some are elderly, we don’t want to deny them the benefits of a good medicine.

In that way, Melmed says the evaluation is not only of patients’ abdominal health but also their environment and well -being.

Adolescents with IBD are known to have higher levels of stress and more difficulty managing a normal life, due to the inability of the attack. And there is no reason to think that this is different for people just because they are younger – or older – more intelligent. But it is even more difficult to grieve when an old age is diagnosed if it is not looked after, and living at home or lack of community support is accepted as normal. But that’s not necessary, say the experts.

“As doctors, we’re always looking at the lung,” NYU’s Hong said. “But really, what’s important: What does this old patient want to do? Do they want to go? Or do they want to run a train around the park?” And that’s where experts say when they talk about the risks and benefits of looking at it carefully. “Just because they’re older doesn’t mean they don’t deserve the same kind of education. live, “said Hong.” Don’t be underestimated. “

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