Medical comorbidity and distress in patients with irritable bowel syndrome: The moderating role of age☆
Introduction
Irritable bowel syndrome (IBS) is a chronic and potentially disabling disorder that afflicts approximately 25 million Americans. Individuals aged 25–54 [1] have higher rates of IBS than other age groups, causing IBS to often be regarded as a “young person's disease”. However, recent studies suggest that IBS is more common among older individuals than previously believed [2], [3]. The lower prevalence of IBS among older adults may be a function of low sensitivity of diagnostic criteria in this age group [4]. Another factor that may influence detection of IBS is the higher prevalence of medical comorbidities among older adults [3]. Amid a variety of medical problems, IBS may not be considered clinically meaningful or may be thought to be part of the natural course of aging.
Medical comorbidity among patients with IBS may not only present a unique diagnostic challenge for clinicians but also may pose a significant burden on patients. Although individuals with IBS and medical comorbidities tend to have worse health outcomes than those with IBS alone [5], the impact of medical comorbidity among older adults with IBS has not been specifically examined. This is an important area of research, given that the older population in the United States is growing rapidly, with those aged 65 and older projected to be 83.7 million in 2050, almost double the rates of 43.1 million seen in 2012 [6]. Adverse effects of IBS may be amplified in older adults because of the additive effect of multiple medical problems; however, little is known about how age influences the association between medical comorbidity and health outcomes in patients with IBS.
The aim of this study was to determine the influence of age on the relationship between number of medical comorbidities and clinically relevant health outcomes in a cohort of severely affected IBS patients. We hypothesized that the relationship between number of medical comorbidities and IBS symptom severity, anxiety, depression, and quality of life would be moderated by age, with older adults experiencing greater IBS symptom severity, higher levels of anxiety and depression, and a lower quality of life than their younger counterparts.
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Participants and procedures
This study is a secondary analysis of a larger National Institutes of Health clinical trial of behavioral treatments for IBS. Patients were recruited primarily through local media coverage and community advertising and referral by physicians in surrounding areas to tertiary care clinics at two academic medical centers in Buffalo, NY, and Chicago, IL. After a brief telephone interview to determine whether interested individuals were likely to meet basic inclusion criteria, patients were
Characteristics of study sample
The distribution of age, number of medical comorbidities, and health outcomes (anxiety, depression, IBS symptom severity, and IBS quality of life), across demographic and clinical features is presented for all participants (Table 1). Patients reported moderate-to-severe IBS (IBS-SSS range: 106–473) with symptoms that were present for many years (M = 16.29 years, SD = 14.08 years). Medical comorbidities were prevalent in the study population, with a range from 0 to 32 comorbidities. The most common
Discussion
This study sought to assess the moderating relationship between age and number of medical comorbidities and IBS symptom severity, anxiety, depression, and quality of life in a sample of patients with severe IBS. We expected older IBS patients with multiple medical problems to experience worse health outcomes (i.e., greater IBS symptom severity, higher levels of anxiety and depression, and a lower quality of life) than younger adults with the disorder. Contrary to our expectations, we found
Competing interests
The authors have no competing interests to report.
Financial Support
This study was funded by National Institutes of Health Grant DK77738 and was partially supported by the facilities and resources of the Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). This research was also supported by the Office of Academic Affiliations VA Advanced Fellowship Program in Mental Illness Research and Treatment, the Department of Veterans Affairs South Central Mental Illness Research Education and Clinical Center (MIRECC). The opinions
Acknowledgments
We would like to thank members of the IBSOS Research Group (Laurie Keefer, Darren Brenner, Rebecca Firth, Jim Jaccard, Leonard Katz, Susan Krasner, Christopher Radziwon, Michael Sitrin, Ann Marie Carosella, Chang-Xing Ma) for their assistance on various aspects of the research reported in the manuscript.
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Representing the IBS outcome study research group
- 1
1021 Main Street, Buffalo, NY 14203–1016.
- 2
(MEDVAMC 152), 2002 Holcombe Blvd., Houston, TX 77030.
- 3
UB Behavioral Medicine Clinic, DK Miller Bldg., Erie County Medical Center, 462 Grider St., Buffalo, NY 14215.