Frailty Assessment May Be Useful for Risk Stratification of Older Adults With IBD

One-quarter of adults with incident (new-onset) inflammatory bowel disease (IBD) are 60 years of age or older. Since chronological age doesn't necessarily predict outcomes, there's a need for tools that could gauge the prognosis of older patients and guide shared decision-making.

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Frailty—a decline in multiple physiologic systems that confers vulnerability to health-related changes—has been associated with readmissions, infections and mortality in studies of IBD patients of all ages. Hamed Khalili, MD, MPH, gastroenterologist and internist in the Clinical and Translational Epidemiology Unit and Division of Gastroenterology at Massachusetts General Hospital, Bharati Kochar, MD, MS, a gastroenterologist in the division, and colleagues recently focused that line of inquiry on older adults, since frailty is an aging-related concept.

In Clinical Gastroenterology and Hepatology they report frailty status is strongly associated with hospitalizations and mortality in older adults with incident IBD.

Methods

Using the Swedish Nationwide Patient Register, the researchers retrospectively studied two cohorts:

• 10,590 patients ≥60 years old who developed IBD between January 1, 2007, and December 31, 2016; mean age was 71 (range, 60–96) and 52% were female
• 103,398 individuals without IBD, matched to the patients on age, sex, place of residency and calendar year

Frailty Status

The researchers assessed frailty in the three years prior to IBD diagnosis (or three years prior to entry into the cohort for the non-IBD comparators) using the Hospital Frailty Risk Score (HFRS), which they assigned retrospectively based on ICD diagnosis codes. The distribution of scores was:

• Nonfrail (score of 0)—39% of IBD patients vs. 73% of comparators
• Low degree of frailty (score >0 but <5)—49% vs. 21%
• Higher degree of frailty (score ≥5)—12% vs. 6%

Effect of Frailty on Outcomes

All patients had at least one year of follow-up. Over the mean follow-up period of five years, IBD patients with HFRS scores ≥5 were at higher risk of:

• All-cause mortality—adjusted HR (aHR), 3.22 compared with nonfrail IBD patients
• All-cause hospitalization—aHR, 2.42
• IBD-specific hospitalization—aHR, 1.50

Frailty was more strongly associated with mortality and all-cause hospitalization in IBD patients 60–69 years of age than in those ≥80 years old. Associations of frailty with mortality and hospitalizations did not differ according to the Charlson Comorbidity Index.

The Path Ahead

This is the first population-based study in IBD that permitted true comparisons of the prevalence of frailty in unselected cohorts, mitigating selection bias. Frailty scores should be studied prospectively to determine whether they are useful as risk stratification and decision-making aid for patients with IBD.

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