J Crohns Colitis. 2024 Apr 23;18(4):516-524.doi: 10.1093/ecco-jcc/jjad175.

Vera E R Asscher ¹, Mar Rodriguez Gírondo ², Jesse Fens ¹, Sanne N Waars ¹, Rogier J L Stuyt ³, A Martine C Baven-Pronk ⁴, Nidhi Srivastava ⁵, Rutger J Jacobs ⁶, Jeoffrey J L Haans ⁷, Lennart J Meijer ¹, Jacqueline D Klijnsma-Slagboom ¹, Marijn H Duin ¹, Milou E R Peters ¹, Felicia V Y L Lee-Kong ¹, Nanda E Provoost ¹, Femke Tijdeman ¹, Kenan T van Dijk ¹, Monse W M Wieland ¹, Mirre G M Verstegen ¹, Melissa E van der Meijs ¹, Annemijn D I Maan ¹, Floor J van Deudekom ⁸, Andrea E van der Meulen-de Jong ¹, Simon P Mooijaart ⁸, P W Jeroen Maljaars ¹

Author information

¹Department of Gastroenterology and Hepatology, Leiden University Medical Centre, Leiden, the Netherlands.

²Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.

³Department of Gastroenterology and Hepatology, HagaZiekenhuis, The Hague, the Netherlands.

⁴Department of Gastroenterology and Hepatology, Groene Hart Ziekenhuis, Gouda, the Netherlands.

⁵Department of Gastroenterology and Hepatology, Haaglanden Medical Centre, The Hague, the Netherlands.

⁶Department of Gastroenterology and Hepatology, Alrijne Hospital, Leiden and Leiderdorp, the Netherlands.

⁷Department of Gastroenterology and Hepatology, Maastricht University Medical Centre, Maastricht, the Netherlands.

⁸Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, the Netherlands.

Abstract

Background and aims: Our goals were to study frailty screening in association with hospitalization and decline in quality of life [QoL] and functional status in older patients with inflammatory bowel diseases [IBD].

Methods: This was a prospective multicentre cohort study in IBD patients ≥65 years old using frailty screening [G8 Questionnaire]. Outcomes were all-cause, acute, and IBD-related hospitalization, any infection, any malignancy, QoL [EQ5D-3L], and functional decline (Instrumental Activities of Daily Living [IADL]) during 18 months of follow-up. Confounders were age, IBD type, biochemical disease activity [C-reactive protein ≥10 mg/L and/or faecal calprotectin ≥250 µg/g], and comorbidity [Charlson Comorbidity Index].

Results: Of 405 patients, with a median age of 70 years, 196 [48%] were screened as being at risk for frailty. All-cause hospitalizations occurred 136 times in 96 patients [23.7%], and acute hospitalizations 103 times in 74 patients [18.3%]. Risk of frailty was not associated with all-cause (adjusted hazard ratio [aHR] 1.5, 95% confidence interval [CI] 0.9-2.4), but was associated with acute hospitalizations [aHR 2.2, 95% CI 1.3-3.8]. Infections occurred in 86 patients [21.2%] and these were not associated with frailty. A decline in QoL was experienced by 108 [30.6%] patients, and a decline in functional status by 46 patients [13.3%]. Frailty screening was associated with a decline in QoL (adjusted odds ratio [aOR] 2.1, 95% CI 1.3-3.6) and functional status [aOR 3.7, 95% CI 1.7-8.1].

Conclusions: Frailty screening is associated with worse health outcomes in older patients with IBD. Further studies are needed to assess the feasibility and effectiveness of its implementation in routine care.