Clinical Characteristics, Frailty, Comorbidity Burden and Hospital Outcomes among Geriatric Patients with Inflammatory Bowel Disease: A Prospective Cross-Sectional Study from a Tertiary Care Teaching Hospital in South India

Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC) and Crohn's disease (CD), is a chronic immune-mediated inflammatory disorder of the gastrointestinal tract characterized by alternating periods of remission and relapse. Although traditionally considered a disease of younger individuals, the prevalence of IBD among older adults has increased due to improved life expectancy, advances in treatment, and the rising incidence of elderly-onset disease. (1) This demographic shift presents unique clinical challenges, as elderly patients often have age-related physiological changes, multiple comorbidities, and increased healthcare needs. (2) Globally, more than seven million people are affected by IBD, with a steadily increasing burden in newly industrialized countries. (3) India has witnessed a significant rise in the incidence and prevalence of both UC and CD, driven by urbanization, changing lifestyles, improved diagnostic capabilities, and greater disease awareness. (4) Consequently, healthcare providers are increasingly managing elderly patients with complex disease requiring long-term medical care and hospitalization. Management of IBD in older adults is complicated by immune senescence, reduced organ function, altered drug metabolism, and common comorbidities such as diabetes, hypertension, cardiovascular disease, chronic kidney disease, osteoporosis, and malnutrition. Polypharmacy further increases the risk of adverse drug reactions, drug interactions, and poor medication adherence. Frailty, functional dependence, and nutritional impairment are increasingly recognized as important determinants of hospitalization, treatment response, postoperative complications, and mortality but remain underassessed in routine clinical practice. Despite the growing burden of IBD in India, data on geriatric patients remain limited, particularly regarding frailty, comorbidity profiles, treatment patterns, and hospitalization outcomes. The present prospective cross-sectional study was conducted among elderly inpatients with IBD at a tertiary care teaching hospital in South India to evaluate demographic and clinical characteristics, frailty, nutritional and functional status, comorbidities, therapeutic management, and short-term hospitalization outcomes. The findings are expected to provide valuable real-world evidence to support individualized, multidisciplinary care and improve clinical outcomes in this vulnerable population.

MATERIALS AND METHODS

Study Design and Setting

A prospective, hospital-based, cross-sectional observational study was conducted to evaluate the clinical characteristics, frailty status, comorbidity profile, therapeutic management, and hospitalization outcomes of geriatric patients with inflammatory bowel disease (IBD). The study was carried out in the Departments of Gastroenterology and General Medicine at a tertiary care teaching hospital in Erode, Tamil Nadu, India, following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Study Population

The study included 81 consecutive hospitalized patients aged ≥60 years with a confirmed diagnosis of ulcerative colitis (UC) or Crohn's disease (CD), established through clinical, endoscopic, histopathological, and radiological findings. Patients with infectious, ischemic, radiation-induced, microscopic, or indeterminate colitis, terminal illness with an expected survival of less than one month, incomplete clinical records, or refusal to participate were excluded.

Ethical Considerations

The study protocol was approved by the Institutional Ethics Committee before commencement. Written informed consent was obtained from all participants or their authorized representatives. Patient confidentiality and anonymity were maintained throughout the study in accordance with the Declaration of Helsinki.

Data Collection

Data were prospectively collected using a structured and prevalidated Case Record Form (CRF). Information obtained included demographic characteristics, disease type and duration, clinical presentation, previous hospitalizations, nutritional status, frailty, functional status, comorbidities, treatment modalities, and hospitalization outcomes. Nutritional assessment was performed using body mass index (BMI), recent weight loss, and evidence of malnutrition. Frailty was evaluated using the Clinical Frailty Scale (CFS), while functional status was assessed according to the patient's ability to perform Activities of Daily Living (ADLs). Comorbid conditions, including diabetes mellitus, hypertension, cardiovascular disease, chronic kidney disease, anemia, osteoporosis, malnutrition, depression, and anxiety, were recorded. Pharmacological management included mesalamine, corticosteroids, immunomodulators, biologic agents, and antibiotics, together with nutritional supplementation and supportive care where indicated.

Outcome Measures

The primary outcomes included the prevalence of UC and CD, comorbidity profile, and frailty status. Secondary outcomes comprised functional dependence, length of hospital stay, intensive care unit (ICU) admission, 30-day readmission, in-hospital complications, and mortality.

Statistical Analysis

Data were entered into Microsoft Excel and analyzed using statistics software. Continuous variables were expressed as mean ± standard deviation (SD) or median (interquartile range), while categorical variables were summarized as frequencies and percentages. Comparisons were performed using the Chi-square test or Fisher's exact test for categorical variables and the student’s t-test or one-way ANOVA for continuous variables. A two-tailed p value of <0.05 was considered statistically significant.

RESULTS

Participant Characteristics

Table 1. Baseline Demographic and Clinical Characteristics of the Study Population

A total of 81 geriatric patients diagnosed with inflammatory bowel disease (IBD) were enrolled in the study. The mean age of the participants was 71.54 ± 5.12 years (range: 65–82 years). Patients aged 70–79 years constituted the largest proportion (56.8%), followed by those aged 60–69 years (37.0%), while only 6.2% were aged ≥80 years. Female patients slightly outnumbered males (56.8% vs. 43.2%). More than half of the study population (61.7%) belonged to the low socioeconomic group, reflecting the predominance of economically disadvantaged patients among hospitalized elderly individuals with IBD. The mean body weight, height, and body mass index (BMI) were 68.75 ± 9.81 kg, 159.83 ± 7.42 cm, and 23.85 ± 3.47 kg/m², respectively. Clinically significant weight loss (>5% during the preceding six months) was observed in 33.3% of patients, indicating a considerable burden of nutritional impairment.

Disease Characteristics

Ulcerative colitis (UC) was the predominant subtype of inflammatory bowel disease, accounting for 85.2% of all cases, whereas 14.8% of patients were diagnosed with Crohn's disease (CD). The median disease duration was 10 years, suggesting that most participants had long-standing disease. At admission, disease activity was distributed relatively evenly across severity categories, with 34.6% of patients presenting with moderate disease, 33.3% with severe disease, and 32.1% with mild disease. These findings demonstrate that clinically significant disease activity remains common among elderly patients requiring hospitalization.

Frailty and Functional Status

Table 2. Frailty and Functional Status of Elderly Patients with IBD

Frailty assessment using the Clinical Frailty Scale (CFS) demonstrated that only 37.0% of participants were classified as fit (CFS 1–3). Approximately one-fifth (22.2%) were categorized as vulnerable (CFS 4), while 30.9% exhibited mild-to-moderate frailty (CFS 5–6). Severe frailty (CFS 7) was observed in 9.9% of the study population. Overall, nearly two-thirds of hospitalized elderly patients exhibited some degree of frailty. Functional assessment revealed that only 35.8% of patients remained fully independent in performing activities of daily living. Partial dependence was observed in 30.9%, whereas 33.3% required complete assistance, highlighting substantial functional impairment among elderly patients hospitalized with IBD.

Comorbidity Profile

A high prevalence of chronic comorbid conditions was observed. Diabetes mellitus was the most frequent comorbidity, affecting 64.2% of patients, followed by hypertension (60.5%). Cardiovascular disease and chronic kidney disease were documented in 35.8% and 32.1% of participants, respectively. Among nutritional and hematological disorders, anaemia was identified in 49.4% of patients, while 32.1% experienced clinical malnutrition. Osteoporosis was present in 13.6% of patients. Regarding psychological health, depression and anxiety were identified in 12.3% and 8.6% of participants, respectively. These findings emphasize the considerable burden of multimorbidity among elderly patients with inflammatory bowel disease.

Table 3. Comorbidity Profile among Geriatric Patients with Inflammatory Bowel Disease

Treatment Patterns

All study participants received pharmacological treatment for active inflammatory bowel disease during hospitalization. Medical therapy included mesalamine (5-aminosalicylic acid), corticosteroids, immunosuppressive agents, biologic therapy, and antibiotics according to institutional treatment protocols. In addition, 56.8% of patients received nutritional supplementation as part of comprehensive supportive care. Only 6.2% had a documented history of previous IBD-related surgery, indicating that most patients were managed conservatively with medical therapy.

Table 4. Pharmacological and Non-pharmacological Management of Patients with IBD

Hospitalization Outcomes

The mean duration of hospitalization was 11.47 ± 4.32 days, with a median hospital stay of 12 days (range: 3–20 days). Intensive care unit (ICU) admission was required in 7.4% of patients. Importantly, no in-hospital mortality was recorded during the study period. The 30-day readmission rate was 16.0%, indicating that approximately one in six patients required rehospitalization within one month following discharge.

In-Hospital Complications

The most frequent complication encountered during hospitalization was gastrointestinal bleeding, affecting 22.2% of patients. Cardiovascular events occurred in 21.0%, while acute kidney injury was documented in 19.8% of cases. Sepsis was observed in 13.6%, whereas pneumonia and Clostridioides difficile infection each occurred in 8.6% of patients. These findings indicate that gastrointestinal, cardiovascular, and renal complications remain major contributors to morbidity among hospitalized elderly patients with inflammatory bowel disease.

Table 5. Hospital Outcomes and In-hospital Complications

Association Between Comorbidities and Clinical Outcomes

The relationship between major comorbidities and hospitalization outcomes was evaluated using Chi-square and Fisher's exact tests. No statistically significant association was identified between diabetes mellitus, hypertension, cardiovascular disease, chronic kidney disease, anaemia, or malnutrition and either ICU admission or 30-day readmission (all p > 0.05). These findings suggest that, within the present cohort, the presence of individual comorbid conditions did not independently predict short-term adverse hospitalization outcomes.

Table 6. Association Between Major Comorbidities and Clinical Outcomes