Risks of Infection among the Older Inflammatory Bowel Disease Patients

Accumulating evidence has demonstrated improved clinical outcomes with earlier initiation of immunosuppressive therapy for patients with inflammatory bowel disease (IBD). However, current evidence-based treatment paradigms are not often applied to the older IBD patients, as they represent a higher-risk group for disease and medication-associated complications, particularly infection. Serious infections, associated with increased hospitalizations, morbidity, and mortality, are more common among the older IBD patients. Although immunosuppression and advanced age are risk factors for infection, additional variables such as increasing disease activity, comorbidity, and declining functional status also play a role. Finding the optimal balance between therapeutic efficacy and safety for older IBD patients with moderate to severe disease activity poses a great challenge to the practicing clinician particularly as the therapeutic armamentarium expands to include more immunologic targets in the future to be used in combination with currently available therapies. Patient selection, looking beyond numeric age, with prompt and appropriate medication prescribing relative to disease activity and corticosteroid dependence is key to maximizing efficacy and decreasing infection-related risks. Additionally, practitioners should be proactive with respect to older IBD patients with an emphasis on preventative care, including vaccinations and nutritional and functional status assessments, to address potentially modifiable risk factors for serious infection.