Older adults compared with younger adults with moderate to severe ulcerative colitis (UC) are more likely to experience colectomy, mortality, and severe infections, according to study results published in Gerontology.
The retrospective cohort study was completed at a single hospital in China, with all included patients hospitalized with a primary diagnosis of UC. Patients aged 60 years and older at time of diagnosis were classified as older adults, while patients aged 16 to 59 years at time of diagnosis were classified as adults. Investigators randomly matched 74 older adults with moderate to severe UC with adult patients of the same sex, disease activity and duration, and admission time. Patients were monitored through their most recent clinic visit or until 2019. Clinical characteristics, treatment, and prognostic outcomes were tracked for all patients.
The primary outcome was UC-related colectomy or death. Secondary outcomes included severe complications, such as bowel obstruction or toxin megacolon, and severe infections.
Older adult patients were significantly more likely to undergo UC-related colectomy than adult patients, at 28.4% and 12.2%, respectively. Colectomy was also sought out sooner in older adult patients, with the operation taking place only 8 months after admission, compared with nearly 40 months for adult patients (P =.001). No deaths were noted in the adult group, but there were 4 deaths in the older adult group.
Serious infections occurred more frequently in older adult patients compared with adult patients (55.4% vs. 35.1%). Infection rates are unlikely to be secondary to treatment with immunomodulators or biologics, as utilization rates were low in both patient groups. While steroid use was comparable in older adult and adult patients, older adults had a lower rate of responsiveness compared with adult patients (76.8% vs 85.7%).
The study may have limited applicability to other patient groups, as it involved a single center. Disease characteristics may vary based on patient genetics and ethnicity. Additionally, treatment guidelines and standards in China differ from those of most Western countries, relying heavily on 5-ASA and corticosteroids and only recently incorporating immunomodulators and biologics.
“The evaluation for disease severity and therapeutic response should be more flexible according to the individual conditions,” the study authors noted. “Considering the poor response to steroids in [older adults], we can try an alternative steroid sparing strategy and increase use of immunomodulator or biologics in these geriatric IBD individuals to prolong colectomy-free survival.”
Zhang M, Lv H, Yang H, Zhang H, Bai X, Qian J. Elderly patients with moderate-to-severe ulcerative colitis are more likely to have treatment failure and adverse outcome. Gerontology. Published online April 6, 2022. doi:10.1159/000522569