Older age and steroid use are associated with increasing polypharmacy and potential medication interactions among patients with inflammatory bowel disease.

Older Americans, aged 65 years and above, represent the fastest growing age group with an estimated 31% increase in the number of older persons during this decade.1 This elderly subgroup, partly due to the implementation of Medicare Part D, also represents the largest consumers of prescription medications with an increased risk of medication-related adverse effects.2,3 Older age is associated with greater comorbidity and polypharmacy, which can add to the risk for medication interactions and adverse effects due to iatrogenesis.4 The National Social Life, Health, and Aging Project reported over 80% of the older patients use at least 1 prescription medication on a daily basis with over 50% taking more than 5 medications or supplements daily.5 With the aging of the population, the number of older patients with inflammatory bowel disease (IBD) is also expected to increase. Little is known about the prevalence of polypharmacy and medication interactions among the older patients with IBD. These factors, potentially overlooked by practicing gastroenterologists, may impact IBD medication adherence, efficacy, and safety and lead to increased morbidity. The older patients with IBD are already a higher-risk group as increased age is associated with an increased risk of serious infections, venous thromboembolic events, hospitalizations, postoperative complications, and mortality.6–9 Elderly patients with IBD also have greater outpatient resource utilization compared with other age groups including physician visits, ambulatory care visits, and pharmacy claims.10,11 There are few studies of the presently available IBD medications that comment on the therapeutic efficacy among the older patients with IBD. The anti-tumor necrosis alpha agents (anti-TNFs), currently among the most effective treatments for moderate to severe disease activity, may be associated with increased serious infection and mortality when administered to the older patients with IBD with higher rates of medication discontinuation due to lack of response or adverse effects.12–14 Corticosteroids are often prescribed to the older patients with IBD, with over 30% geriatric patients with IBD maintained on steroids for greater than 6 months of therapy.15 However, steroids are associated with numerous adverse effects, particularly within the elderly patients with IBD, including infection, hypertension, worsened glycemic control, and bone loss.16 Therefore the optimum treatment strategy, balancing safety and efficacy, for the older patients with IBD has yet to be determined as there are additional factors to consider in addition to disease activity. Studies looking at prescribing patterns among older patients with IBD consistently show aminosalicylates and corticosteroids are often the mainstays of therapy with lower rates of immunomodulator or biological use.15,17,18 These trends may reflect prescribers' concerns about the safety and efficacy of immunosuppression among this higher risk age group; however, the older patients' ability to handle increased disease activity may be less than younger patients. The primary aims of this study were to assess the prevalence and severity of polypharmacy and potential medication interactions within a cohort of older patients with IBD. The secondary aims were to describe the prescribing patterns in the treatment of IBD, particularly relating to disease severity and age at diagnosis.