Prevalence and Appropriateness of Polypharmacy in Older Adults with Inflammatory Bowel Diseases.

BACKGROUND: Despite the growing prevalence of older adults with inflammatory bowel diseases (IBD), polypharmacy, an important geriatric construct, is poorly understood. We described polypharmacy and its implications in older adults with IBD. METHODS: In a cross sectional study of adults ≥ 60 years with IBD, we obtained medication lists from the medical record and patients. We assessed medications by the Beer's criteria, anti-cholinergic burden and drug-drug interactions. We constructed multi-variate logistic regression models to assess association between polypharmacy with low quality-of-life, controlling for age, sex, IBD-type, number of comorbidities and depression. RESULTS: In 100 adults ≥ 60 years with IBD, with a median age of 68 years, 56% met criteria for remission by a validated disease activity index. Polypharmacy, defined as ≥ 5 concomitant medications, was noted in 86% of the cohort and 45% had severe polypharmacy, defined as ≥ 10 concomitant medications. In this cohort, 48% were on ≥ 1 medication that met Beer's criteria for potentially inappropriate in older adults and 24% had a cumulative anti-cholinergic drug burden score of ≥ 3, the threshold for serious adverse events attributed to anti-cholinergic burden. Serious drug-drug interactions were found in 26% with 7% involving an IBD medication. Controlling for potential confounders, polypharmacy, defined both numerically (OR 22.79, p < 0.01) and by medication appropriateness (OR 1.95, p < 0.01), was significantly associated with low quality of life. CONCLUSION: Polypharmacy is prevalent in older adults with IBD and independently associated with low quality of life. Describing polypharmacy can guide de-prescription strategies tailored to GI clinic for older adults with IBD.

Differences in Management and Outcomes of Older and Younger Adults with Acute Severe Ulcerative Colitis.

BACKGROUND: Older adults with ulcerative colitis (UC) have greater morbidity than younger adults. The goal of this study was to investigate differences in the management and outcomes of older and younger patients hospitalized with severe UC. METHODS: We conducted a retrospective cohort study of patients hospitalized for acute severe ulcerative colitis requiring intravenous steroids. We compared outcomes of adults > 65 years with younger patients. Primary study outcomes included frequency and timing of medical and surgical rescue therapy during the hospitalization, postoperative complications, frailty, and mortality outcomes up to one year following the hospitalization. RESULTS: Our cohort included 63 older adults (≥65 years) and 137 younger adults (14-64 years). Despite similar disease severity at hospitalization, older adults were half as likely to receive medical rescue therapy (odds ratio 0.45, 95% CI 0.22 - 0.91). This difference was more striking among the frailest older adults. Older patients were similar likely to undergo surgery but were more likely to undergo urgent or emergent procedures (50%) compared to younger patients (13%) (p<0.004). The fraction of older adults at high-risk for frailty increased from 33% pre-hospitalization to 42% post-hospitalization. Nearly one-third (27.8%) of older adults died within one year of hospitalization with half the deaths among older adults being attributable to UC or complications of UC. CONCLUSIONS: In comparison to younger patients, older adults had lower frequency use of medical rescue therapy, higher rates of emergency surgery, and increased mortality within one year. Further research is needed to optimize care pathways in this population.