Even if your Crohn’s diagnosis is recent — as many as 23 percent of people with IBD are diagnosed at age 60 or older, suggests a study done in Sweden and published in February 2018 in the journal Gastroenterology — there are special considerations for older adults compared with younger people. For example, older adults are more likely to be managing more than one health condition and taking multiple medications, which can impact Crohn’s treatment. Your Crohn’s disease itself can also change as you age: Your symptoms may worsen, lessen, or simply take on different forms. It’s important to discuss any such changes with your healthcare team so you can work with your doctors to reduce symptoms and prevent long-term complications. Follow these seven tips for navigating Crohn’s disease as a senior. It’s important to get screened for these conditions, says Dr. Hanauer, and make sure you’re monitoring any conditions you have. In addition, it’s important to stay up to date with all vaccinations, including those for pneumonia, shingles, and the flu. Older people’s immune systems aren’t as strong as those of younger people, says Hanauer, which is why it’s even more important for you to get your vaccinations, especially if you’re taking an immunosuppressant drug. People with Crohn’s may also be more susceptible to infections and other conditions, according to Christina Y. Ha, MD, an associate professor of medicine in the Inflammatory Bowel Disease Center and gastroenterologist at Cedars-Sinai in Los Angeles. For example, if you have diabetes and your blood sugar is very high, you’re at greater risk for infections.
2. Look Out for Drug Reactions and Interactions
While other health conditions can, by themselves, complicate your approach to Crohn’s treatment, “The major issue is the impact of medications,” says Hanauer. For example, if you’re taking a blood thinner for cardiovascular issues, you may be at greater risk for Crohn’s-related gastrointestinal bleeding. In addition, taking corticosteroids to treat a Crohn’s flare can lead to bone loss, which can be especially risky if your bone density is already low, Hanauer notes. Antibiotics are another drug to watch out for, says Dr. Ha, because they can increase the risk of a C. difficile infection in older adults. This type of bacterial infection can range from unpleasant to life threatening, and can increase the risk of Crohn’s disease–related complications, she says. Ha notes that both your primary-care doctor and gastroenterologist should be looking out for drug interactions, since these can make Crohn’s disease and other conditions worse. And in some cases, it may be advisable to work with other doctors to simplify your drug regimen. But the most important drug-related concern in older adults, according to Ha, is steroid treatment for Crohn’s. Sometimes, she says, a short course of steroids may be necessary. “But we are immediately thinking about what the steroid-sparing treatment strategy should be.” “Steroids can result in problems such as worsened diabetes control, bone loss, or cardiovascular disease, which could require even more medications to treat, says Ha.
3. The Symptoms of a Flare May Be Different in Older Adults
According to a review published in September 2020 in the journal Digestion, older adults with Crohn’s are less likely than younger people to have abdominal pain, diarrhea, and anemia during a flare. Instead, they’re more likely to experience weight loss, fever, and constipation. Crohn’s disease may produce milder symptoms in older adults, according to Hanauer. But, he notes, it can still lead to the same complications that younger adults sometimes experience, including intestinal scarring, bowel obstruction, and a higher risk of colorectal cancers. The frequency of your Crohn’s flares may also depend on how long you’ve had the disease. According to a review published in May 2019 in the journal Drugs & Aging, people diagnosed with Crohn’s at an older age appear to have a lower rate of disease progression than either younger people or those over 60 who were diagnosed at a younger age.
4. If Your Symptoms Increase or Disappear, Revisit Your Treatment With Your Doctor
Sometimes, says Ha, a person’s Crohn’s disease may seem to “burn out” with age, becoming less and less active. If you’ve been taking the same Crohn’s medication for several years with no disease activity, she says, it may be worthwhile to discuss with your doctor whether you need to be taking it at all. But this “burning out” is relatively uncommon, Ha says. And in many cases, an older person’s Crohn’s disease continues to progress, but they stay on the same treatment out of habit — or fear of what a new drug regimen might involve. That unknown new treatment, says Ha, is likely to be better than having a constant Crohn’s flare because you’re taking the wrong medication.
5. Make Sure Your Crohn’s Disease Isn’t Masking Other Conditions
A number of issues can cause digestive problems with age, Hanauer notes, including reduced saliva production, stomach-acid production, and pancreatic function. Sometimes, unrelated digestive problems may be mistaken for a Crohn’s flare, resulting in unnecessary treatment that doesn’t solve the underlying issue. Especially with digestive symptoms, Ha says, it’s important to avoid what’s known as a prescribing cascade in which, for example, a doctor prescribes an antidiarrheal drug that causes abdominal pain and constipation, which may then require more drugs. Instead, it’s important to find and treat the root cause of the diarrhea, if possible, such as an infection or pancreatic insufficiency, she says.
6. Eat a Healthy Diet and Look Out for Malnutrition
It’s normal for older people to experience a change in appetite that leads them to eat less, according to Ha. But it’s especially important that people with Crohn’s disease eat enough calories. Not eating enough can weaken the immune system and increase your risk of infections. To help boost or keep up your caloric intake, Ha recommends eating smaller, more frequent meals throughout the day, rather than the traditional three large meals. Older people with Crohn’s should also be monitored for common nutrient deficiencies, which may happen because reduced stomach-acid production can affect the absorption of nutrients such as calcium and iron. It’s also important to get your vitamin D, vitamin B12, and zinc levels tested, according to Ha. You may end up needing to take supplements of these nutrients. If you have trouble tolerating oral iron supplements, IV supplementation is often a good alternative, she says.
7. Pay Special Attention to Dental Care
As you get older, Hanauer says, it’s increasingly important to make sure your teeth are working well if you have Crohn’s. “If people can’t chew their food, they’re going to have other problems,” he notes. Gastroenterologists often neglect to ask older patients about their dental care, says Ha, even though it’s important. When your ability to chew is impaired, she notes, it can lead to a lower caloric intake and reduced appetite. To ensure good dental health, Ha recommends that you see your dentist at least annually, making sure any dentures or partials are fitting well, and practice good oral hygiene, including brushing and flossing your teeth regularly.
