Differences in Management and Outcomes of Older and Younger Adults with Acute Severe Ulcerative Colitis

Older adults with ulcerative colitis (UC) have greater morbidity than younger adults. The goal of this study was to investigate differences in the management and outcomes of older and younger patients hospitalized with severe UC.We conducted a retrospective cohort study of patients hospitalized for acute severe ulcerative colitis requiring intravenous steroids. We compared outcomes of adults > 65 years with younger patients. Primary study outcomes included frequency and timing of medical and surgical rescue therapy during the hospitalization, postoperative complications, frailty, and mortality outcomes up to one year following the hospitalization.Our cohort included 63 older adults (≥65 years) and 137 younger adults (14-64 years). Despite similar disease severity at hospitalization, older adults were half as likely to receive medical rescue therapy (odds ratio 0.45, 95% CI 0.22 - 0.91). This difference was more striking among the frailest older adults. Older patients were similar likely to undergo surgery but were more likely to undergo urgent or emergent procedures (50%) compared to younger patients (13%) (p<0.004). The fraction of older adults at high-risk for frailty increased from 33% pre-hospitalization to 42% post-hospitalization. Nearly one-third (27.8%) of older adults died within one year of hospitalization with half the deaths among older adults being attributable to UC or complications of UC.In comparison to younger patients, older adults had lower frequency use of medical rescue therapy, higher rates of emergency surgery, and increased mortality within one year. Further research is needed to optimize care pathways in this population.