P-111 Geriatric Patients with Inflammatory Bowel Disease are Less Likely to be Treated with Immunomodulating Agents

Abstract

Inflammatory bowel disease (IBD) is a lifelong illness that affects approximately 1.4 million in the United States. While there is an increasing geriatric population in the nation, there is limited published data on older IBD patients. The effect of aging physiology on IBD manifestations is unknown. Small prior studies have shown decreased use of immunomodulating agents in elderly IBD patients. However, the effect of age upon treatment regimens in elderly IBD patients is unknown. This study evaluated the use of immunomodulator therapy in geriatric IBD patients. A retrospective chart review of inflammatory bowel disease patients cared for in a 18-month period at a university medical center was performed. There were no exclusion criteria. Patient age, gender, race, disease type and treatment regimen were obtained. Geriatric age was defined as ≥65 years. A database, maintaining patient confidentiality, was created. Statistical analysis was performed using Fisher’s exact test with statistical significance set at P < 0.05. The study was approved by the university institutional review board. 293 medical records of IBD patients were reviewed. There were 175 women and 118 men. One hundred fifty-six patients had Crohn’s disease, 135 had ulcerative colitis and 2 had indeterminate colitis. The mean age was 41.04. Two hundred seventy-one (163 women, 108 men) were <65 years. Twenty-two (14 women, 8 men) were ≥65 years. One hundred sixty-one of the 293 (55%) patients were on immunomodulating therapy. One hundred fifty-six of the 271 (57.6%) patients <65 and 5 of 22 (22.7%) of geriatric patients were on immunomodulating therapy. Geriatric IBD patients were found to be significantly less likely (P = 0.0029) to be treated with immunomodulating agents than non-geriatric patients. There was no significant difference in the use of immunomodulating therapy in women <65 and women ≥65 or (P = 0.0847) or in men <65 and men ≥65 (P = 0.1503). The importance of recognizing disease presentation and prescribing patterns in elderly IBD patients is increasingly important. This study revealed that immunomodulating agents are used less frequently in geriatric IBD patients. The decreased utilization of immunomodulator therapy in geriatric patients may reflect less severe disease, patient preference or prescriber caution due to co-morbidities and the potential for adverse medication reactions. Further study should be performed to evaluate the influence of aging upon inflammatory bowel disease management.