Meta-Analysis: Prevalence of Frailty and Associated Adverse Events in Inflammatory Bowel Diseases

Background: The number of adults aged over 60 years with inflammatory bowel disease (IBD) is increasing. Frailty, rather than chronological age, may be a better predictor of adverse health outcomes.

Aims: To summarise current knowledge about frailty in adults with IBD including the prevalence and associations of frailty and IBD-related adverse outcomes.

Methods: We performed an electronic search of MEDLINE, EMBASE and EMBASE Classic databases using search terms for IBD and frailty from inception to 14 February 2024. All studies involving adults aged ≥ 16 with a confirmed diagnosis of IBD that included a frailty assessment were eligible for inclusion.

Results: We included 23 observational studies involving 1,893,448 adults. Risk of bias was low for 18 studies and moderate for five. Twelve methods of frailty assessment were used, the most common being the Hospital Frailty Risk Score. Pooled prevalence of frailty in IBD patients was 18% (95% confidence interval (CI) 12.4%-25.6%). Meta-analysis of unadjusted events data demonstrated that frailty increased the risk of infection-related admissions following treatment in two studies (relative risk (RR) 1.9; 95% CI 1.2-3.0), post-operative morbidity in three (RR 2.0; 95% CI 1.4-2.7) and mortality in seven (RR 4.3; 95% CI 2.6-7.4).

Conclusions: Frailty is common in patients with IBD and is associated with IBD-related adverse outcomes including infection-related admissions following treatment, post-operative morbidity and death. Future work should focus on developing risk assessment tools to better support decision making for older people with frailty and IBD.