Life with IBD
Getting diagnosed with ulcerative colitis (UC) later in life can feel disorienting. You may have assumed that inflammatory bowel disease was something that affected younger people, or you may have spent months attributing your symptoms to something else entirely. You're not alone in that experience. Up to 15% of new UC diagnoses occur in people over 60, and recent research suggests that number is growing as the population ages. Late-onset UC is a recognized clinical pattern with its own diagnostic hurdles, treatment considerations, and monitoring needs. Understanding those differences can help you work more effectively with your care team.
Why Diagnosis Takes Longer After 60
One of the defining challenges of late-onset UC is that it often takes longer to identify. On average, patients with inflammatory bowel disease experience a 16-month diagnostic delay from the time symptoms appear in primary care, and older adults tend to fall on the longer end of that range.
The delay happens because UC symptoms in older adults overlap with several other conditions that are common in the same age group. Bloody stool, abdominal cramping, and changes in bowel habits can look like diverticular disease, ischemic colitis, or even colorectal cancer. Diverticular disease is the most frequent misdiagnosis, partly because diverticula are so prevalent in people over 60 that they can be found on imaging regardless of whether they are causing symptoms. A related condition called segmental colitis associated with diverticulosis can look nearly identical to UC on biopsy, adding another layer of complexity.
Late-onset UC also presents slightly differently than younger-onset disease. Older adults are more likely to report weight loss and less likely to have rectal bleeding as a prominent symptom compared to younger patients. Left-sided colitis is more common, while disease limited to the rectum is less common. These differences can make UC harder to suspect in the first place, especially for doctors who may not be actively looking for a new IBD diagnosis in a patient over 60.
How Treatment Decisions Change With Age
Once diagnosed, treating UC in older adults requires a more careful balancing act. The medications are largely the same ones used in younger patients, but the risk calculations shift because of the realities of aging: more medications for other conditions, higher baseline infection risk, and greater cardiovascular vulnerability.
Corticosteroids, often the first line of treatment for a flare, illustrate this well. Older adults with UC respond to steroids at a lower rate than younger patients, roughly 77% compared to 86%. Prolonged steroid use also carries amplified risks in older bodies, including bone loss, elevated blood sugar, and increased susceptibility to infection.
For patients who need stronger therapies, the choice of biologic or small molecule medication deserves particular attention. Anti-TNF medications like infliximab and adalimumab appear to work similarly in older and younger patients, but they carry increased infection risk in the elderly population. Janus kinase (JAK) inhibitors such as tofacitinib present a specific concern: post-marketing data have shown elevated risk of cardiovascular events and blood clots in patients over 50 who already have cardiovascular risk factors. Current guidance recommends that JAK inhibitors be used only when other options are unavailable for patients with these risk profiles.
Newer biologics like vedolizumab and ustekinumab are increasingly considered preferred options for older patients because of their more targeted mechanisms and favorable safety profiles. Your gastroenterologist should be weighing your full medication list, cardiac history, and infection risk when recommending a therapy, and these conversations may need to include your primary care doctor or cardiologist as well.
Monitoring Needs That Start Immediately
For people diagnosed with UC before age 60, cancer surveillance colonoscopies typically begin 8 years after symptom onset. The logic is that the cumulative inflammation over time is what raises colorectal cancer risk, and younger patients have a window before that risk becomes significant.
For older adults, the timeline compresses. Age itself is already a risk factor for colorectal cancer, and adding UC-related chronic inflammation on top of that means surveillance often needs to start sooner after diagnosis. Research in patients over 75 with long-standing UC found that nearly 40% had dysplasia or cancer detected on surveillance colonoscopy, reinforcing why monitoring in this population matters. Your gastroenterologist will likely recommend a surveillance schedule based on your specific disease extent, duration, and overall health.
Infection monitoring also takes on greater importance. Older adults with UC face a significantly higher rate of serious infections compared to younger patients, around 55% versus 35% in study populations. Cytomegalovirus reactivation, bacterial infections, and herpes zoster are among the more common concerns. If you are starting immunosuppressive therapy, your doctor should review your vaccination history and may recommend updating certain vaccines before beginning treatment.
Working With Your Care Team
Managing UC after 60 often means coordinating between multiple doctors. Your gastroenterologist may be prescribing an immunosuppressive medication while your cardiologist manages blood pressure drugs and your primary care doctor oversees diabetes medications. Each specialist needs to understand the full picture, because drug interactions and compounding side effects become more likely with every medication added.
Keeping organized records of your symptoms, medications, and lab results makes these conversations more productive. When you walk into an appointment with clear data on how your symptoms have changed since your last visit, your doctor can make faster and more informed decisions. This is especially true when multiple providers are involved and may not have real-time access to each other's notes.
Track your medications and symptoms with Aidy to bring clear data to your GI appointments. With multiple medications and conditions, organized data helps your doctors coordinate care safely.