BY KATHERINE HARMON COURAGE
APRIL 8, 2022 2:23 PM EDT
Inflammatory bowel disease (IBD) has long been thought of as an ailment of middle, or even young, adulthood. The chronic illness—which includes Crohn’s disease and ulcerative colitis, and can cause abdominal pain, diarrhea, bleeding, and decreased quality of life—impacts about 3.1 million people in the U.S.
期以，炎症性病(IBD)一直被是，中年、或甚至年的疾病。慢性疾病包括，致腹痛、腹、出血及生活量下降的克恩病及性炎。於美大影310人。
However, it is far from a disease only of the young and middle-aged. More than a quarter of people with IBD are elderly, a figure that is projected to climb to 30% by 2030, according to a 2021 Gastroenterology & Hepatology article.
不，非只於青、中年的疾病。根2021年，一篇胃病及肝病的文，超四分之一的IBD病患是年的，估到2030年，字攀升至30%。
Even more underappreciated is the growing population of people who are diagnosed with the disease after they turn 60. Whereas IBD was once taught as a disease with two spikes in onset—20s to 30s, and 40s to 50s—doctors are learning there is a third spike that begins later in life.
更被低估的是，越越多人在60後，被罹患疾病。在病上，管IBD曾被教一，具有20到30多及40多到50多，高峰的疾病。不，生正在悉，有始於以後生活中的第三高峰。
“Now we know you can be 75 and get IBD,” says Dr. Simon Hong, a gastroenterologist and IBD specialist at NYU Langone Health. Regardless of when the disease starts, however, understanding—and treating—IBD in older adults comes with its own set of challenges and intricacies.
美大(NYU：New York University)朗格尼健康中心，胃病家及IBD家，Simon Hong博士宣：「目前，我知道，人是75，罹患IBD。」不，疾病何始，解及治年者的IBD，皆伴著其自身的一系列挑及性。
Hundreds of thousands of people whose IBD was diagnosed earlier in their lives are now living with the disease in older age. For many that means living with the damage the disease has done to their intestinal tract, and sometimes with the altering impacts of surgery done to manage it, such as ostomy pouches or increased incontinence. Not to mention continued flare-ups.
於生命早期，十被IBD的人。目前，正著於年之年，具有此疾病的生活。於多人，那意味著生活具有，疾病其道已造成的。因此，有具有了妥善理疾病，而行手之多改的影，如造袋或尿失禁增加。更不用，持的。
It used to be commonly thought that disease activity tapered off in older age, and some people do find their IBD becomes inactive later in life. But that isn’t always the case, says Cleveland Clinic gastroenterologist Dr. Jessica Philpott. “I certainly see some patients who develop more aggressive disease as they advance in age,” she says.
去，人普遍，那疾病的活性，著年增逐少，而且有些人他的IBD，在以後的生活中，得不活。不，克利夫所(非利性的美中心)的胃病家，Jessica Philpott博士表示，情非是如此。她宣：「我看到一些，著年增，展更具侵患性疾病的患者。」
For individuals who get IBD after they turn 60, the disease can look somewhat different than for those who have had it for decades. Whereas younger Crohn’s patients can have damage in any part of their intestinal tract, in older-onset cases it more often primarily affects the colon.
在60之後，罹患IBD的而言，疾病看起有不同於，那些已罹患十年的人。管，年的克恩病患者，於其道的任何部分有。不，在年病的病例中，往往主要更常影。
As people age, diagnosing a new case of IBD also gets more challenging. There are numerous, more common reasons an elderly person might experience, for example, bloody diarrhea. This alarming symptom is one of the first reasons for IBD evaluation in a younger person.
著人年的增，新的IBD病例，也得更具挑性。年者可能多、更常的原因，譬如出血性腹。令人的症，是於年人中，行IBD估的首要原因之一。
But for someone in their 60s or older, doctors often need to rule out a host of other conditions—including infection, ischemia of the colon, other forms of colitis, diverticulitis, and cancer—before they look into IBD as a potntial cause.
不，於60多或以上的人，生通常需要排除多其他疾病，包括感染、缺血、其他形式的炎、憩室炎及癌症，才能IBD 在原因。
And because older adults have often already faced more health issues, they might not seek medical help as promptly. Crohn’s in particular can be trickier to pinpoint than ulcerative colitis, as it might present as intermittent abdominal pain and weight loss, which aren’t uncommon in older adults generally. These factors can sometimes delay proper diagnosis, and thus effective treatment, by years.
同，由於年者通常已面多的健康，他可能不立即求助。特是，克恩病是比性炎更。因，它可能表歇性腹痛及重。在年者中，不罕。此些因素有延正，而延有效治年。
Dr. Gil Melmed, director of inflammatory bowel disease clinical research at Cedars-Sinai Medical Center in Los Angeles, recounts the story of one patient who is now 84. She had been hospitalized numerous times for abdominal pain and bloody diarrhea.
美Cedars-Sinai中心(位於加州洛杉市)，炎症性病床研究主任，Gil Melmed博士述了，一名目前84，因腹痛及出血性腹，曾住院多次的病患情。
Doctors repeatedly diagnosed her with diverticulitis and treated her with antibiotics. Her symptoms would get better for a while and then return. Then the antibiotics led to additional complications, including a dangerous C. difficile infection.
生反覆她罹患憩室炎，用抗生素行治。她的症好一段，然後。後，抗生素致了外的症，包括危的辨梭芽孢菌(C. difficile：Clostridioides difficile)感染。
When Melmed first saw her, after yet another hospital admission, he realized she wasn’t suffering from diverticulitis at all but Crohn’s disease. Hong has seen this misdiagnosis cycle countless times. “Doctors do have to always remember to have IBD on their list” for people who are older, he says.
Melmed第一次到她，是在另一次住院後。他意到，她根本有罹患憩室炎，而是克恩病。Hong已反覆看到次。 他宣：於年者而言，「生必始住，IBD列於他的名上。」
The rate at which people are getting late-onset IBD appears to be increasing, likely because of environmental triggers like air pollution, which makes being vigilant even more important.
人罹患性IBD的比率，似乎增加中。很可能是由於，像空污染的境因所造成。使得保持警惕，得更加重要。
At its core, IBD is a disease of chronic inflammation. Aging itself is also linked with increased inflammation, a connection that has given rise to the term inflammaging. So aging patients with IBD are at even greater risk for many of the classic inflammation-linked health outcomes, including cardiovascular disease, cancer, obesity, skin issues, arthritis, and skeletal muscle loss.
在其重要部分，IBD是一慢性炎症疾病。衰老本身也增加的炎症被起，性已致了，炎一。因此，罹患IBD的年病患冒有，炎症相之典型健康果的多大，包括心血管疾病、癌症、肥胖、皮、炎及骨骼肌失。
Experts caution that some common health complaints may look similar to those of older adults without IBD, but in reality the IBD has triggered a different issue. For example, joint pain in an older patient might first appear to be osteoarthritis, but if they have IBD, it may well be a different form of arthritis altogether.
家警告，一些常的健康，可能看那些有IBD的年者相似。不，上IBD已引一不同的。譬如，於年之病患中的疼痛，可能最初是骨炎。不，倘若他罹患IBD，很可能是，完全不同形式的炎。
Older IBD patients also have increased risks for other conditions including osteoporosis, colon and skin cancers, blood clots, and general physical deconditioning.
年的IBD病患，也有增加之包括，骨疏症、癌及皮癌、血栓一般身能失等，其他疾病的。
The long list of potential health issues increases the importance of standard preventative care, including good nutrition and exercise, as well as simple things like routine immunizations, Melmed notes. Until recently, many vaccines for older adults contained live virus, making them riskier to mix with some IBD therapies.
Melmed特指出，一串的在健康，增加了防保健的重要性。包括良好的及，及像例行的免疫接等，事情。直到最近，多供年者使用的疫苗，具有活病毒。使得它有高的，一些IBD法混合在一起。
This is no longer the case, he says, and in fact, because so many IBD treatments suppress the immune system—and aging itself is associated with an increased risk of infections—it is especially important for these patients to get regular vaccines for things like pneumonia.
他表示，不再是此。事上，因如此多的IBD治抑制免疫系，而衰老本身增加的感染有。因此，此些病患而言，定期接像肺炎等，事的疫苗特重要。
There are still many unknowns about the intricacies of the aging body as it is impacted by IBD, and vice versa. For example, we don’t yet know much about how aging with IBD looks different for women going through menopause and afterward, and what role menopause treatments might play in the disease course.
由於受IBD影，有衰老之身的性，仍然有多未知，反之亦然。譬如，有罹IBD，更年期及之後的女性，衰老看起有何不同，及在此疾病程中，更年期的治可能扮演什角色，我不太解。
Some small studies have found a modest protective role for estrogen-replacement therapies for IBD disease activity, but the answers aren’t yet definitive. “We really need more data in this area,” says Dr. Sunanda Kane, who specializes in IBD and women’s health at Mayo Clinic in Rochester, Minn.
一些小型研究已，雌激素替代法於IBD疾病的活性，具有度的保角色。不，此些答案尚未定。於美明尼州切斯特市梅所，研究IBD及女性健康的Sunanda Kane博士宣：「在此域，我需要更多的。」
But even something as big as menopause can be missed—or misinterpreted—when doctors are overly focused on a patient’s IBD and its treatments. Kane recalls one 57-year-old patient who was on a newer monoclonal antibody therapy for her ulcerative colitis.
不，生度著重於病患的IBD及其治，即使是像更年期大的事，也被漏或解。Kane回起一名57，因她的性炎，接受一更新之克隆抗治的病患。
One day the patient told her primary-care doctor that she was having “fevers” and “confusion.” The doctor concluded she was likely suffering from a rare brain infection as a result of her IBD medication, told her to discontinue her medication, and referred her to a neurologist.
有一天，病患告其初保健生，她“”且“不清”。 生推，她可能由於服用IBD 物，而罹患罕的部感染。因此，告她停止服，她介神科生。
While the patient waited anxiously for her neurology appointment, she called Kane to ask what other IBD medication she could take instead. Kane listened to the patient’s story and realized that her symptoms were those of menopause.
病患焦急等待其神科，她打Kane，她可以服用什其他IBD物。Kane聆了此病患的情，意到她的症是更年期的那些症。
Back on her previous IBD treatment and estrogen-replacement therapy, the patient ended up doing well, Kane reports. But it served as a reminder that the presence of IBD can cloud the assessments of a patient’s full picture, especially when big health changes come up, as they so often do during the aging process.
Kane述，回到她之前的IBD治及雌激素替代治，患者最表良好。不，提醒人，IBD的存在糊(影)，病患整情的估。特是，出重大健康化，就像在衰老程中，她很常生那。
One thing that has become clear as more people live with IBD into older age is that when evaluating patients for IBD and their treatment prospects, it’s not just about age.
一件著愈多人入老年，著具有IBD的生活，而得清晰的事，是就IBD而言，估病患及其治前景，不只是有年。
Experts now advocate basing decisions on one’s frailty score over chronological age. And like inflammation, the combination of aging and IBD increases the odds of frailty, which puts someone at greater risk for poor health outcomes.
目前，家主根一人，在足年之弱分的多判。果炎症一，衰老IBD的合，增加了身弱的率，使某人面更大健康不佳的。
As anyone ages, treating illness tends to get more challenging. There are more comorbidities, a lengthening list of medications, and a person’s overall health to take into account. These factors become even more important when considering IBD therapies. “Anything we do, from procedures to treatment, it’s different for someone that’s older,” says Cleveland Clinic’s Philpott.
任何人著年的增，治疾病向得更具挑性。有更多的合症、增的物清及考量，一人的整健康。在考IBD治，此些因素得更加重要。克利夫所的Philpott宣：「我做的任何事，做法到治，年者而言，是不同的。」
Once the disease advances to a particular state, doctors often look to surgery to remove the damaged part of the intestinal tract. This, however, is not always an option for extremely frail patients with IBD, no matter what their chronological age.
一旦疾病展到特定，生通常求，手切除道受部分。不，度弱的IBD病患，他的足年如何，非是一。
The disease, of course, can typically be managed well with medication. But there are some common pitfalls, warn specialists who work with elderly IBD patients.
然，疾病通常能以物，被十分妥善理。不，有些常伏的危，提醒以年之IBD病患，行研究的家。
One of the biggest concerns in pharmaceutical treatments for older IBD patients is susceptibility to infection, because nearly all IBD drugs in some way tamp down the immune system, which is already on the decline with age. But this concern, say experts, can lead to vast undertreatment of the condition—or treatments with even riskier forms of drugs.
在年之IBD病患物治中，最大的之一，是感染的易感性。因，乎所有IBD物皆以某方式抑制，已著年增，而下降的免疫系。不，家表示，致，病的大治不足，或具多的物治法。
For decades, corticosteroids have been a standby of IBD therapy. And they are still indicated for short-term treatment of mild to moderate disease flare-ups, particularly in younger adults.
十年，皮固醇一直是，IBD治的一用物。而且它仍然示，合度至中度疾病的短期治，特是在年者中。
But their long-term use, especially for older adults, is less effective than other options, and can actually bring higher risks, including for hypertension, diabetes, bone loss, infection, osteoporosis, and overall mortality.
不，它的期使用，特是年者而言，效果少於其他，而且上高，包括高血、糖尿病、骨流失、感染、骨疏症及全面死亡。
Nevertheless, some 30% of elderly IBD patients have been prescribed steroids for more than six months at a time, according to a 2015 study in Inflammatory Bowel Diseases.
然而，根2015年，一炎症性病的研究，年的IBD病患，大30%一次服用固醇，超六月。
Part of the reason, NYU’s Hong says, is that because of these drugs’ long history, “they’re seen as sort of the ‘safe’ option.” Instead, he says, “I would argue that rather than being on steroids for a long period of time, it would be much better to be on one of the new biologics.”
大的Hong表示，部分原因是，由於些物的悠久史。「它被一‘安全’的。」 不，他宣：「我其期服用固醇，不如服用一新的生物，要好得多。」
In the past couple of decades, small molecule “biologics” have entered the scene as a newly established treatment for IBD. Particularly effective are drugs like antitumor necrosis factor agents.
在去的十年中，作一新近被之IBD治法的小分子“生物”，已入了此域。特有效的是，像抗瘤死因子的物。
Some clinicians are reluctant to prescribe these medications, however, because they are known to increase the risk of cancer, such as lymphoma, especially in older adults. Some doctors even recommend surgery—which comes with its own not insubstantial risks for older individuals—before trying biologics.
不，有些床生不意立些物。因，已知它增加罹患癌症(如淋巴瘤)的，特是在年者中。有些生甚至建，在生物之前，行手。年的而言，有其自身非足重的。
Melmed’s 84-year-old patient who was finally diagnosed with Crohn’s disease was immediately started on biologics, and has yet to have another flare-up. Melmed acknowledges there are risks with these drugs for older patients.
Melmed的84病患，最罹患克恩病。他立即始使用生物，而且一直再。Melmed承，使用此些物，年病患而言，有多。
But he looks at the larger picture of “how to best benefit a patient,” he says. “There’s no risk-free option. Just because somebody’s older, we certainly don’t want to deny them the potential benefits of an effective therapy.”
不他表示，他是考量“如何使病患益最大”的大格局。「有的。我不想，只因某人年，而否它有效治的在益。」
As part of that approach, Melmed advocates assessing not just patients’ intestinal health but also their environment and well-being.
作那方法的一部分，Melmed主不估，病患的道健康情，而且要估他的境及安。
Younger people with IBD are known to have higher rates of depression and greater challenges navigating normal life, because of the unpredictability of attacks. And there’s no reason to think this would be different for people just because they are a few years—or decades—wiser.
所周知，罹患IBD的年者，具有高的抑症比率，且由於作的不可性，因此有多大挑，引著正常生活。因此，有理由，人而言，只因早察年或十年，有所不同。
But depression can be more difficult to spot in an elderly patient if it isn’t screened for, and being fairly homebound or lacking social support might be accepted as normal. Yet it doesn’t have to be that way, experts agree.
不，倘若不被，在年的病患中，抑症是更。也就是，是相困居家中，或缺乏社的扶持，因此被正常。然而，家一致，情非一定如此。
“As doctors, we’re always focused on inflammation,” NYU’s Hong says. “But in reality, what matters is: What does this older patient want to do? Do they want to travel? Or ride a bike around the park?”
大的Hong宣：「作生，我始著重於炎症。不上，重要的是：位年的病患想做什？他想旅行？是在公，自行？
And that’s where experts say the conversation around treatment risks and benefits should focus. “Just because they’re older doesn’t mean that they don’t deserve the same quality of life,” Hong says. Don’t settle for less.”
因此，那是家所，在治及益上，聚焦的地方。Hong宣：「只因年不意味著，不得到同的生活品。不要足於此。」
址：https://time.com/6165526/ibd-and-aging/?utm_medium=email&utm_source=sfmc&utm_campaign=newsletter+brief+default+ac&utm_cOntent=+++20220416+++body&et_rid=207513678&lctg=207513678
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