Geriatric syndromes in intestinal failure: An accelerated aging phenomenon in middle adulthood patients?

Abstract

Aging is a progressive deterioration of organ systems, involving molecular and cellular changes known as hallmarks of aging. These alterations affect all body systems and may contribute to the development of geriatric syndromes-multifactorial conditions resulting from the interaction of biological, psychological, and social factors that tend to accumulate over time, thereby increasing morbidity and mortality in older adults. Several studies have documented the presence of these hallmarks in diseases considered as models of accelerated aging. Furthermore, some of these mechanisms have been reported to be involved in the pathophysiology of Chronic Intestinal Failure (CIF), contributing to cellular structural damage and exacerbating the complications associated with this condition. This suggests a possible link between CIF and the process of accelerated aging. To date, no studies have evaluated whether patients with CIF receiving ambulatory parenteral nutrition therapy develop geriatric syndromes before the age of 65. Therefore, this study aimed to assess the presence of geriatric syndromes in adults aged 40-70 years diagnosed with CIF and undergoing ambulatory parenteral nutrition therapy. A non-probabilistic, consecutive sampling method was used between September 2024 and January 2025. All patients underwent a comprehensive geriatric assessment to identify the presence of geriatric syndromes such as multimorbidity, visual impairment, malnutrition, cognitive decline, depression, reduced mobility, polypharmacy, frailty, incontinence, falls, and functional dependency in basic and instrumental activities of daily living. The study included a total of 14 participants enrolled in the home parenteral nutrition program, with a mean age of 58.3 ± 13 years; 64.3 % were women and 35.7 % were men. Of the cases, 14.2 % of cases were secondary to enteric fistula, 14.2 % to gastrointestinal dysmotility, 14.2 % to intestinal obstruction, and 7.1 % to extensive mucosal disease due to familial adenomatous polyposis. Additionally, 21.3 % of cases were associated with systemic sclerosis, and 28.4 % were due to short bowel syndrome. When comparing chronological age with phenotypic age using epigenetic clocks, the mean chronological age was 58.3 ± 13 years, while the median phenotypic age, according to PhenoAge, was 67.5 (60.5-82.5) years-indicating premature metabolic aging in this population. It was documented that 100 % of participants had at least five geriatric syndromes, with up to 57.1 % exhibiting ten or more. The polypharmacy syndrome was present in 92.9 % of participants, with a mean daily intake of 9.3 ± 3.08 medications. Additionally, 64.3 % were dependent in at least one basic activity of daily living, and 92.9 % were unable to perform at least one instrumental activity. A high probability of phenotypic frailty according to the FRAIL questionnaire was observed in 78.6 % of participants, while 92.9 % were classified as frail based on deficit accumulation using the Clinical Frailty Scale. The prevalence of probable sarcopenia was 42.9 %, and 21.4 % met the criteria for a falls syndrome. The Timed Up and Go test reclassified 50 % of the participants as high risk for falls. In the mental health domain, 57.1 % had a high likelihood of depressive disorder according to the Geriatric Depression Scale, and 92.9 % showed abnormal cognitive performance on the Montreal Cognitive Assessment, with scores considered low for their age and educational level. Our study found a high prevalence of geriatric syndromes in a population not typically classified as older adults. In conclusion, Chronic Intestinal Failure appears to represent a pathological model in which multiple metabolic, inflammatory, epigenetic, and social alterations converge, potentially contributing to premature aging in middle adulthood patients.

Keywords: Accelerated aging; Geriatric syndrome; Intestinal failure.