Existential Reflections by Older Adults With Inflammatory Bowel Diseases on Medical and Surgical Treatments

Current treatment guidelines do not address the unique health risks or life priorities of the aging population with inflammatory bowel diseases (IBD). Patient priority-directed care approaches can facilitate better clinical management for this population. We aimed to explore the experiences of older adults with IBD in relation with medical and surgical treatments by investigating the factors that influence their decision making.

We conducted qualitative in-depth interviews with 22 patients aged 60 years or older who spoke English and received treatment of IBD at our center. We designed the interview guide using the Patient Priorities Care conceptual model to evaluate motives behind treatment decisions and goals. We used qualitative description and reflexive theoretical analysis to identify underlying themes specific to the lived experience of older adults with IBD.

Responses fit into 3 domains: (A) treatment decisions, (B) treatment reflections, and (C) treatment goals. Themes featured importance of trust in shared decision making, resignation, acceptance, impact of treatments, anticipatory anxiety, finding meaningful life through treatment, maintaining remission, de-escalating medical therapy, and restoring normalcy. We found that having IBD at an older age creates a unique identify conflict. We learned that the most commonly identified treatment outcome is to feel "normal." Patients felt resigned and anxious when making treatment decisions, yet grateful for the chance of remission.

Supporting older adults with IBD to feel less resigned with their disease is critical. Providers should consider redefining what "feeling normal" means to facilitate disease acceptance and present treatment information with minimal bias.