Frailty in Patients With Inflammatory Bowel Disease

Older individuals comprise a growing proportion of patients with inflammatory bowel disease (IBD). Assessing older patients for frailty, defined as an age-related decline in multiple physiologic systems, is increasingly recognized as important for risk-stratifying patients with IBD. Mechanistically, both persistent chronic inflammation and common microbial perturbations may predispose patients with IBD to the development of frailty. In those with IBD, frailty is associated with an increased risk for mortality that is independent of age and comorbidity. Among hospitalized patients, frailty is associated with a higher risk for readmission and postoperative complications. In patients starting on immunomodulator or tumor necrosis factor-alpha antagonist therapy, frailty is also associated with an increased risk for infectious complications, including serious infections. For a beneficial effect on patient outcomes, it is important that clinicians familiarize themselves with the tools for assessing frailty and implement interventions aimed at mitigating the individual components of the frailty phenotype. This article examines the proposed mechanisms for an association between frailty and IBD, tools for assessment of frailty, and data involving the impact of frailty on outcomes in patients with IBD.