Older people and inflammatory bowel disease: a systematic review

Abstract

To review the literature on inflammatory bowel disease in older and younger people and to identify whether they included a nursing or psychosocial perspective, or were informed by theories of ageing. Inflammatory bowel disease, manifested as Crohn's disease and ulcerative colitis, affects younger and older people and is associated with a range of psychosocial factors. Nurses have an important role to play in caring for people with inflammatory bowel disease. A systematic review of literature related to inflammatory bowel disease and older people was carried out using the MEDLINE, CINAHL EMBASE and Cochrane databases between 1990-2006. Generally speaking, the clinical features of inflammatory bowel disease are similar in younger and older people, as are indications for surgery, survival and the usual wide spectrum of severity of disease. Corticosteroid treatment carries additional risk for older people. The studies used both retrospective and prospective designs, with the former using patient records, and the latter using follow-up of patients with inflammatory bowel disease. Sample sizes were adequate for statistical analyses but there was no reference to reliability or validity of data collection methods. None of the studies considered psychosocial aspects, or the role of nurses in caring for people with inflammatory bowel disease. A specific gerontological perspective was lacking from the papers reviewed. While the clinical features of inflammatory bowel disease are similar in younger and older people, with the bimodal distribution of age of onset of inflammatory bowel disease, the possibility exists that quality of life and adjustment in older people depend on age of onset. This has not been investigated. Future lines of enquiry taking psychosocial aspects of inflammatory bowel disease into account in older people are explored. Nurses play an increasingly important role in the assessment and management of inflammatory bowel disease patients. Little is known about factors which could predict poorer psychosocial health and the impact non-intestinal manifestations may have on this in older people with inflammatory bowel disease.