Frailty in inflammatory bowel disease: a missing link in personalized care for the aging IBD population

Frailty is a potentially reversible condition that reflects decreased physiological reserve and is increasingly recognized in older patients with inflammatory bowel disease (IBD). Although frailty is frequently associated with advanced age, multi-morbidity, and disease severity, this condition represents a distinct clinical syndrome with independent prognostic significance that warrants dedicated assessment.

We performed a narrative review of studies exploring frailty in patients with IBD, focusing on definitions, prevalence, assessment tools, clinical implications, and interventions.

Two main conceptual models of frailty have been applied to IBD: the phenotypic model, an individual-level assessment defining frailty as a syndrome; and the cumulative deficit model, which is suited for retrospective identification. While eleven frailty tools have been used in IBD studies, none were specifically designed or validated for the IBD patient population. Owing to heterogeneous definitions and populations, the reported prevalence of frailty in IBD patients ranges from 6% to 62%. Frailty is associated with increased risks of hospitalization, prolonged hospitalization, postoperative complications, infections, and mortality. Key drivers of frailty in IBD include fatigue, sarcopenia, and malnutrition, common features of IBD that may share mechanisms. While these factors contribute to frailty, the syndrome itself independently predicts adverse clinical outcomes. Current limitations include heterogeneous definition, underrepresentation of older patients, lack of longitudinal data, and absence of IBD-specific tools.

Frailty is a critical, under-recognized determinant of poor outcomes in IBD. Systematic screening and integration into care pathways could improve patient stratification and management. Future research should aim to validate specific assessment tools and test interventions to ameliorate frailty in older IBD patients.