TOPLINE

Older adults (≥ 65 years) with lower gastrointestinal bleeding (LGIB) presented with more severe bleeding, higher comorbidity burden, and substantially worse 30-day outcomes compared with younger adults. Mortality in older patients was predominantly driven by non-bleeding-related causes.

METHODOLOGY

• Researchers conducted a retrospective, multinational cohort study across 11 centers in seven European countries, and included 1058 consecutive adults (mean age, 73 years) presenting to emergency departments with LGIB between January and December 2024.
• Patients were stratified into older (77.3%; aged ≥ 65 years) and younger (22.7%; aged < 65 years) groups.
• The primary outcome was 30-day mortality; secondary outcomes included hospital and ICU admission, length of hospital stay, 30-day readmission, in-hospital mortality, need for red blood cell transfusion, and requirement for endoscopic, radiological, or surgical intervention.
• Bleeding risk scores (Oakland, age-blood tests-comorbidities [ABC], and acute lower gastrointestinal bleeding and in-hospital mortality [ALIBI]) were calculated to assess severity. Older adults demonstrated significantly higher bleeding risk scores (Oakland, 21.0 vs 15.7; ABC, 4.0 vs 1.44; and ALIBI, 8.94 vs 3.6) compared with younger adults (P < .001 for all).

TAKEAWAY

• Overall 30-day mortality was 11.7% and was more than twice as high in older adults adults than in younger adults (13.7% vs 5.0%; P < .001), and 89.3% of deaths in older patients were due to non-bleeding-related causes.
•  ALIBI score (odds ratio [OR], 1.26 per point; 95% CI, 1.14-1.39), ABC score (OR, 1.25 per point; 95% CI, 1.15-1.36), and Charlson Comorbidity Index (OR, 1.25 per point; 95% CI, 1.14-1.37) were independently associated with 30-day mortality (P < .001 for all).
• Older patients had higher rates of hospital admission (84.2% vs 62.1%; P < .001), longer length of stay (12.2 vs 9.1 days; P = .016), greater 30-day readmission rate. (8.8% vs 6.3%; P = .022), red blood cell transfusion (50.9% vs 25.0%; P < .001). ICU admission were more common among younger adults (9.2% vs 4.6%; P = .004).
• Endoscopy was performed in most patients (90% of younger and 83.4% of older adults), and rates of endoscopic therapy, interventional radiology, and surgery were similar between age groups.

IN PRACTICE

"LGIB in ageing populations represents a shifting clinical paradigm," the authors wrote. "[LGIB] should prompt a broader clinical assessment incorporating multimorbidity, frailty, and medication exposure."

SOURCE

The study was led by Francisco Vara-Luiz, Department of Gastroenterology, Hospital Garcia de Orta, Unidade Local de Saúde Almada-Seixal, Almada, Portugal. It was published online on July 9 in The Lancet Regional Health - Europe.

LIMITATIONS

The limitations included retrospective design, restriction to 30-day outcomes, and reliance on electronic medical records. The inverse association between age and ICU admission may have been influenced by unmeasured factors, and frailty was not formally assessed.

DISCLOSURES

The study was supported by FCT–Fundação para a Ciência e a Tecnologia. One author reported grants, honoraria, and other payment support from Instituto de Salud Carlos III, Asociación Española de Gastroenterología, Sociedad Española de Endoscopia Digestiva, Adacyte Therapeutics, various other companies and organizations. The remaining authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.