Key takeaways

  • Nearly 1 in 3 US adults aged 65 and older live with a disorder of gut-brain interaction (DGBI), yet this group remains underrepresented in clinical trials.¹
  • Older patients are often told symptoms are "just part of aging" – many cycle through years of trial-and-error before finding effective symptom management.
  • Nerva, a guideline-aligned 6-week gut-brain therapy program, is now available at no cost to all US-based patients aged 65 and older.
  • Referring clinicians receive structured outcomes data at the start and end of the program, supporting continuity of care without adding to consultation time.
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The Nerva gut-brain therapy program is now available at no cost to all US-based patients aged 65 and older – a group that is common in gastroenterology practice but underrepresented in clinical research.

Older adults with disorders of gut-brain interaction (DGBIs) are too often told their symptoms are part of getting older. Many have cycled through years of dietary changes and medication trials before anyone names the gut-brain mechanism behind what they're experiencing. 

Read on to understand what makes DGBI care in older adults distinct, what the evidence supports for brain-gut behavioral therapy in this population, and how to refer eligible patients to Nerva at no cost.

Why gut-brain care in older adults is uniquely complex

Nearly one in three US adults aged 65 and older meet criteria for at least one DGBI, according to the Rome Foundation Global Epidemiology Study of 54,127 adults across 26 countries.¹ These patients are common in your clinic. The challenge is that the standard gut-brain care playbook doesn't always translate cleanly to this age group.

Four factors shape how DGBI care plays out for these patients:

  • Symptoms are attributed to aging. Chronic bloating, altered bowel habits, and abdominal discomfort can overlap with age-related changes in motility and continence, making the underlying gut-brain disorder harder to surface. The diagnosis often gets delayed.
  • Polypharmacy narrows options. Neuromodulators – often a workhorse for IBS pain – carry real risks in older adults, from anticholinergic burden to falls and interactions with cardiac and psychotropic medications.²
  • Behavioral therapies are recommended but hard to find. ACG, AGA, and NICE all recommend brain-gut behavioral therapies, but the trained workforce is small and concentrated in major cities.³ For an older patient, "find a GI psychologist who takes your insurance" is often a dead end.
  • Patients have often stopped raising it. By the time they reach a specialist, many have spent years with normal workups and have learned to stop bringing it up.
"Our IBS patients typically have suffered from five to seven years before they have seen me or somebody else and somebody has even diagnosed them with IBS." – Dr. Jeffrey Nathanson, Gastroenterologist, Comprehensive Gastrointestinal Health

For older patients, that window often stretches longer. After years of normal workups, many have stopped expecting a clear answer from any single appointment.

Gut-directed hypnotherapy for IBS in older adults: What the evidence shows

Gut-directed hypnotherapy is a guideline-recommended first-line intervention for DGBIs, with response rates in clinical trials sitting in the 70–80% range and benefits maintained for at least 12 months.³ 

The Nerva randomized controlled trial, published in the American Journal of Gastroenterology in 2025, found that 81% of participants achieved a clinically significant improvement on the IBS-SSS, and 71% had a clinically significant reduction in abdominal pain by the end of the 6-week program.⁴

The gap is what we know specifically about older adults. 

A 2026 systematic review identified just eight studies directly addressing the pathophysiology, diagnosis, and treatment of IBS in patients aged 60 and over.⁵ A 2024 editorial in Alimentary Pharmacology & Therapeutics put it directly: as the proportion of adults aged 65+ rises globally, DGBI trials need to actively recruit older adults to build an age-specific evidence base.⁶

That gap is not just about volume of evidence. The underlying biology shifts with age in ways that affect how DGBIs present and respond to treatment. Visceral hypersensitivity – the core peripheral mechanism in IBS – appears less prevalent in older patients, with rectal sensory thresholds rising stepwise across age groups.⁷ ⁸ Polypharmacy, comorbidity, and age-related changes in central pain processing further shift the clinical context in which any treatment is delivered.

The therapeutic logic of brain-gut behavioral therapy still applies in older adults – the gut-brain axis remains active, central processing remains modifiable, and the intervention is non-pharmacological with no known drug interactions. But the evidence base for how it performs in this specific population is thin, and that is what expanded access is designed to start changing.

How Nerva performs in older adults specifically

In Nerva's internal cohort, adults aged 65 and older complete the program at substantially higher rates than under-65 patients and engage more consistently throughout, with comparable symptom improvement. It's an early signal, but a meaningful one – the patients most often dismissed as "set in their ways" are the ones showing up day after day.

Nerva is now no-cost for your US patients aged 65 and older

Nerva is available at no cost to all US-based patients aged 65 and older. There is no insurance paperwork, no eligibility forms for you to complete, and no out-of-pocket cost for your patient. We handle eligibility, onboarding, and clinical support from the moment the referral lands, and you receive baseline and end-of-program outcomes covering symptom severity, anxiety and depression screening, and functional impairment.

"We hear the same thing from clinicians every week – my patient needs this, but they can't afford it. That's why we're starting with US patients 65 and older – it's a group that's been underrepresented in research and faces real barriers to accessing behavioral therapy, and we want to change both." – Alex Naoumidis, Co-Founder and Co-CEO, Mindset Health

If you'd like to discuss patient eligibility, the referral process, or how Nerva fits into care for your 65+ patients, reach out to Nerva's New York-based clinical specialists, Emily Mahadeo or Chloe Millar, or book a quick call to get your questions answered.

To refer an eligible patient, complete the secure online form at nerva.mindsethealth.com/refer or by fax at 212-377-0271. 

Frequently asked questions

Is gut-directed hypnotherapy safe for older adults on multiple medications?

Gut-directed hypnotherapy is a non-pharmacological intervention with no known drug interactions, making it well-suited to older patients managing polypharmacy.² It can be used alongside existing medications without dose adjustments.

Other than IBS, what others disorders is Nerva appropriate for?

Nerva is appropriate across upper and lower GI gut-brain disorder presentations, such as functional dyspepsia, reflux hypersensitivity, and functional constipation. It is also for patients with overlapping conditions such as SIBO, GERD, and IBD. 

How do older patients access Nerva if they aren't comfortable with technology?

Older patients can receive human support from Nerva's specialist team throughout the program, from onboarding through to completion. The daily sessions are short and designed to be simple to follow at any age.

Is there an upper age limit, or contraindications to consider for older adults?

Nerva has no upper age limit and the no-cost offer applies to all US-based patients aged 65 and older. The standard contraindications apply across age groups – severe psychiatric instability or active psychosis – and red-flag GI symptoms should be worked up before referral.

How long will my patient have access?

Patients have access at no cost for at least 12 months. Access continues at no cost unless Nerva communicates any change to your patient in advance.

Who covers the cost?

Nerva absorbs the cost of the program for eligible 65+ patients. 

How is this different from Nerva's Patient Assistance Program?

The Patient Assistance Program (PAP) provides graduated cost coverage (25%–100%) for patients of any age experiencing financial hardship, with a brief means-tested application. The US 65+ no-cost pathway is separate – eligibility is based on age and US residency, not financial need.

Why might Nerva ask my patient for Medicare details during sign-up?

Nerva may collect Medicare details to confirm eligibility and to prepare for future reimbursement-related options that may become available. Providing them does not change access – Nerva remains at no cost to your patient.

Do older patients actually complete the 6-week program?

Older patients tend to engage well with structured, short-format programs that fit into a daily routine, and Nerva's 15-20 minute sessions are designed with that in mind. The specialist support team follows up throughout the program to help patients stay on track if engagement drops.

  1. Sperber AD, Freud T, Palsson OS, Bangdiwala SI, Simren M. The aging gastrointestinal tract: epidemiology and clinical significance of disorders of gut-brain interaction in the older general population. Aliment Pharmacol Ther. 2024;60(4):446-456. doi:10.1111/apt.18103
  2. Luo Y, Shah BJ, Keefer LA. Special considerations for the management of disorders of gut-brain interaction in older adults. Curr Treat Options Gastroenterol. 2022;20(4):582-593. doi:10.1007/s11938-022-00403-z
  3. Lacy BE, Pimentel M, Brenner DM, et al. ACG clinical guideline: management of irritable bowel syndrome. Am J Gastroenterol. 2021;116(1):17-44. doi:10.14309/ajg.0000000000001036
  4. Peters SL, Anderson E, Halmos EP, Gibson PR. Comparison of digitally delivered gut-directed hypnotherapy program with an active control for irritable bowel syndrome. Am J Gastroenterol. 2025;120(2).
  5. Anumolu A, van Rooyen D, Olsen Kilburn L, Thakur ER, van Tilburg MAL, Moshiree B. Impact of IBS on older adults: a narrative and systematic review of diagnostics, quality of life considerations, and therapies including pharmacologic and non-pharmacologic. Curr Treat Options Gastroenterol. 2026;24(1):1. doi:10.1007/s11938-026-00488-w
  6. Black CJ. Editorial: Disorders of gut-brain interaction – Don't forget the older person. Aliment Pharmacol Ther. 2024;60(4):527-528. doi:10.1111/apt.18151
  7. Algera JP, Blomsten A, Khadija M, et al. Distinct age-related characteristics in patients with irritable bowel syndrome: patient reported outcomes and measures of gut physiology. npj Gut Liver. 2024;1(1):10. doi:10.1038/s44355-024-00010-y
  8. Beckers AB, Wilms E, Mujagic Z, et al. Age-related decrease in abdominal pain and associated structural- and functional mechanisms: an exploratory study in healthy individuals and irritable bowel syndrome patients. Front Pharmacol. 2021;12:806002. doi:10.3389/fphar.2021.806002
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