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Gastrointestinal and Psychological Outcomes of the Nerva Digital Brain-Gut Behavioral Program in Adults Aged 65 Years and Older: A Retrospective Cohort Study
ABSTRACT
Background:
Disorders of gut-brain interaction (DGBI), including irritable bowel syndrome (IBS), are common in older adults and are associated with substantial symptom burden and impaired quality of life. Brain-gut behavioral therapies are recommended in international clinical guidelines, however, evidence in adults aged 65 and older, particularly for digitally delivered interventions, remains limited.
Objective:
To evaluate gastrointestinal outcomes, psychological outcomes, and program engagement among adults aged 65 years and older completing a digital brain-gut behavioral program.
Methods:
A retrospective cohort analysis was conducted in adults aged 65-100 years who completed the Nerva digital brain-gut behavioral program between March 2019 and June 2026. Gastrointestinal symptoms were assessed using 0-100 mm visual analogue scales (VAS) and psychological symptoms were assessed using the Patient Health Questionnaire-4 (PHQ-4). Changes from baseline to program completion, age-stratified outcomes, and associations between engagement and symptom improvement were evaluated.
Results:
A total of 9,085 adults aged 65–100 years were included. Significant within-person improvements were observed across all gastrointestinal outcomes (P<.001). Abdominal pain improved by a median of 21 mm on the 100-mm VAS, with 59.5% of participants achieving a clinically meaningful improvement. Similar improvements were observed across overall gastrointestinal symptoms, abdominal bloating, stool satisfaction, and passage of wind. Mean PHQ-4 scores decreased from 5.57 to 3.20, while the prevalence of positive anxiety and depression screens decreased from 62.1% to 25.2% and from 36.0% to 13.7%, respectively (all P<.001). Gastrointestinal improvements were consistent across participants aged 65–84 years, with no meaningful association between age and psychological outcomes. Median session completion increased from 49 sessions among participants aged 65–69 years to 60 sessions among those aged 85 years and older.
Conclusions:
Older adults who completed a digital brain-gut behavioral program demonstrated substantial improvements in gastrointestinal and psychological outcomes, with little evidence that improvement or engagement diminished with increasing age. These findings challenge the assumption that chronological age is a barrier to engaging with app-based brain-gut behavioral programs and support the inclusion of older adults in future controlled studies. The retrospective, single-arm design precludes causal inference, and prospective controlled trials are needed to establish efficacy in older adults.
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