Rusher Alison, Fuss Alexandra, Araka Elizabeth, Cauley Christy, Cizginer Sevdenur, Ritchie Christine, Ananthakrishnan Ashwin N, Kochar Bharati
Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Harvard Medical School, Boston, Massachusetts, USA.
Am J Gastroenterol. 2025 Apr 7;120(8):1829-1838. doi: 10.14309/ajg.0000000000003475.
Current treatment guidelines do not address the unique health risks or life priorities of the aging population with inflammatory bowel diseases (IBD). Patient priority-directed care approaches can facilitate better clinical management for this population. We aimed to explore the experiences of older adults with IBD in relation with medical and surgical treatments by investigating the factors that influence their decision making.
We conducted qualitative in-depth interviews with 22 patients aged 60 years or older who spoke English and received treatment of IBD at our center. We designed the interview guide using the Patient Priorities Care conceptual model to evaluate motives behind treatment decisions and goals. We used qualitative description and reflexive theoretical analysis to identify underlying themes specific to the lived experience of older adults with IBD.
Responses fit into 3 domains: (A) treatment decisions, (B) treatment reflections, and (C) treatment goals. Themes featured importance of trust in shared decision making, resignation, acceptance, impact of treatments, anticipatory anxiety, finding meaningful life through treatment, maintaining remission, de-escalating medical therapy, and restoring normalcy. We found that having IBD at an older age creates a unique identify conflict. We learned that the most commonly identified treatment outcome is to feel "normal." Patients felt resigned and anxious when making treatment decisions, yet grateful for the chance of remission.
Supporting older adults with IBD to feel less resigned with their disease is critical. Providers should consider redefining what "feeling normal" means to facilitate disease acceptance and present treatment information with minimal bias.
当前的治疗指南并未涉及患有炎症性肠病（IBD）的老年人群独特的健康风险或生活优先事项。以患者优先事项为导向的护理方法有助于对这一人群进行更好的临床管理。我们旨在通过调查影响其决策的因素，探讨老年IBD患者在医疗和手术治疗方面的经历。
我们对22名60岁及以上、讲英语且在我们中心接受IBD治疗的患者进行了定性深入访谈。我们使用患者优先事项护理概念模型设计了访谈指南，以评估治疗决策背后的动机和目标。我们采用定性描述和反思性理论分析来确定老年IBD患者生活经历中特有的潜在主题。
回答分为三个领域：（A）治疗决策，（B）治疗反思，以及（C）治疗目标。主题包括共同决策中信任的重要性、顺从、接受、治疗的影响、预期焦虑、通过治疗找到有意义的生活、维持缓解、减少药物治疗强度以及恢复正常状态。我们发现老年时患有IBD会产生独特的身份认同冲突。我们了解到最常确定的治疗结果是感觉“正常”。患者在做出治疗决策时感到顺从和焦虑，但对缓解的机会心怀感激。
支持患有IBD的老年人减少对疾病的顺从感至关重要。医疗服务提供者应考虑重新定义“感觉正常”的含义，以促进对疾病的接受，并以最小的偏差呈现治疗信息。
