There are several key considerations in terms of diagnosis, treatment and management for inﬂ ammatory bowel disease (IBD) patients over 65. Those who have had disease for a long time may have better and more developed coping skills; therefore, attention can be focused on other aspects of care. Approximately 10-30 percent of incident IBD cases are over the age of 60, and of these, 10 percent are in their 80s (Grimm and Friedman 1990; Jones and Hoare 1988; Piront et al. 2002). For those with new onset disease, coping with a chronic illness that often manifests as pain or diarrhea, usually accompanied by fatigue, is much harder. The concept of “Fit vs. Frail” when considering the older patient may drive treatment decisions. Certainly, a 75-year-old patient who still plays tennis three times a week should not be regarded as the same as one who has multiple co-morbidities and is conﬁ ned to their home.