The ECCO Topical Review on IBD in the ageing population provides guidance on the increasingly recognised challenges of caring for older patients. The review begins by defining 'older adults' and distinguishing between those ageing with longstanding paediatric- or adult-onset disease and those presenting with true elderly-onset IBD. It evaluates clinical features, phenotypic presentations and the broad differential diagnosis of symptoms in this demographic, alongside the key diagnostic roles of ileocolonoscopy and faecal calprotectin.
This Topical Review addresses the complex relationship between advanced medical therapies, surgery and age-related factors such as frailty, polypharmacy, immunosenescence, sarcopenia and existing comorbidities. It supports incorporating structured geriatric assessments, using validated tools for frailty, cognition, functional status and comorbidity, into routine evaluation, ensuring care is individualised rather than driven by chronological age alone.
Regarding colorectal cancer surveillance, the established role of screening endoscopy is re-examined for older adults. Decisions surrounding ongoing surveillance must be tailored to individual disease-related risk factors, prior dysplasia, endoscopic findings, comorbidity burden, estimated life expectancy and procedural risk.
This Topical Review highlights critical considerations across clinical management, perioperative care and surgical decision-making while pointing out significant research gaps resulting from the historic underrepresentation of older adults in IBD trials.
