Esophagus to Small Intestine
Am J Gastroenterol. 2025;120(7):1636-1644
Older adults with celiac disease are at increased risk of frailty: A nationwide cohort study
Introduction: Celiac disease (CeD) is increasingly diagnosed in older adults, though few studies have explored complications in this group. As frailty confers increased risk for adverse events, the authors aimed to explore frailty in older adults with CeD.
Methods: In a nationwide Swedish cohort, the authors identified adults ≥ 60 years with incident CeD between 2004 and 2017 and matched them to population-based controls without CeD by age, sex, county, and calendar-period. Baseline frailty within 3 years before CeD diagnosis or index date was assessed using the Hospital Frailty Risk Score. Among those without baseline frailty, the authors used conditional logistic regression to estimate odds ratios and 95% confidence intervals of future frailty at 5 years comparing CeD with controls. Logistic regression was used to evaluate the association between persistent villous atrophy versus mucosal healing and frailty in patients with CeD.
Results: A total of 4,646 older adults with CeD were matched to 21,944 non-CeD individuals. Baseline frailty was increased in patients with CeD (54.4%) compared with controls (29.7%, p < 0.001), which existed across all frailty categories: low-risk (43.4% vs. 23.8%), intermediate-risk (10.3% vs. 5.4%), and high-risk (0.8% vs. 0.6%). Among those without baseline frailty, patients with CeD had a 61% increased risk of overall frailty at 5 years (95% confidence interval: 1.46–1.78). Mucosal healing in CeD individuals on follow-up biopsy did not protect against future frailty.
Discussion: Older adults with CeD were significantly more likely to become frail than matched comparators. This analysis reveals the increased vulnerability that older patients with CeD are likely to experience.