Frailty in Inflammatory Bowel Diseases

项目总结和摘要 炎症性肠病（IBD）包括克罗恩病（CD）和溃疡性结肠炎（UC 胃肠道（GI）的炎症状况影响超过300万美国人。IBD传统上是一种 IBD是年轻人的疾病，但IBD具有双峰发病率，第二个高峰发生在70岁时。 人口老龄化、死亡率下降以及发病率和患病率上升导致了一个突出的问题， 老年IBD患者增加：26%的美国IBD患者年龄≥65岁。IBD患者有老年性 早期症状。然而，与衰老相关的结构，如虚弱，对IBD活动的影响， 并发症未知。在回顾性研究中，虚弱相关的诊断代码在IBD中更普遍 患者，与免疫抑制后感染的几率接近两倍， 死亡率。与年轻IBD患者相比，老年IBD患者的疾病和治疗相关结局较差 成年人了脆弱结构已成功地用于对癌症和终末期肝病患者进行风险分层 疾病确定虚弱与IBD活动性和并发症的关系对于全面评估IBD的治疗效果至关重要。 评估老年人并对接受免疫抑制治疗IBD的老年患者进行风险分层。的目标 该建议是使用Fried虚弱表型来表征患有IBD的≥60岁成人中的虚弱。目标 量化虚弱和IBD活动之间的关联，并评估虚弱对IBD活动的纵向影响。 IBD和治疗相关并发症。我们已成功开展了一项试验性研究，招募了≥60例患者 在一个旨在研究虚弱的队列中，在这个队列中，我们将收集 人口统计学、IBD相关信息、药物、患者报告结局（PRO）以及疾病- 具体活动指数。我们将使用握力评估疲劳、意外体重减轻和身体功能 力量，步态速度和PRO以及管理脆弱老人量表（VES）。我们将重复这些 在基线评估后6个月和12个月进行纵向随访。这一提议将是第一个 老年IBD患者虚弱的前瞻性研究。在常规临床护理中定位虚弱评估 IBD患者是先锋。描述那些在生理上更适合承受 免疫抑制疗法可以扩大老年人有效类固醇保留疗法的使用。为 职业发展，这项建议将促进我在IBD患者衰老相关过程的研究， 提供必要的培训，将老年医学原理应用于IBD。此外，这些目标将产生 有竞争力的NIA K应用程序所需的数据，以开发IBD老年人的多中心队列， 了解脆弱机制和定制脆弱工具的实用性，以风险分层老年人需要 用于治疗IBD的免疫抑制剂。这条道路将为开发领先的 该研究计划的总体目标是改善IBD老年人的护理。

PROJECT SUMMARY AND ABSTRACT Inflammatory bowel diseases (IBD), comprised of Crohn’s disease (CD) and ulcerative colitis (UC), are chronic inflammatory conditions of the gastrointestinal (GI) tract affecting over 3 million Americans. IBD is traditionally a disease of the young, but IBD has a bimodal incidence with the second peak occurring in the 7th decade of life. The aging population, decreasing fatality and the rise in incidence and prevalence have led to a prominent increase in older adults with IBD: 26% of Americans with IBD are ≥65 years. IBD patients have geriatric syndromes at earlier ages. Yet the impact of aging-related constructs, such as frailty, on IBD activity and complications are unknown. In retrospective studies, a frailty-related diagnosis code was more prevalent in IBD patients, associated with nearly twice the odds of infections after immunosuppression and nearly triple the odds of mortality. Older adults with IBD have poorer disease and treatment related outcomes compared with younger adults. Frailty constructs have successfully been used to risk stratify patients with cancers and end stage-liver disease. Determining the relationship of frailty with IBD activity and complications is critical to comprehensively assess older adults and risk stratify older patients receiving immunosuppression for IBD treatment. The goal of this proposal is to use the Fried frailty phenotype to characterize frailty in adults ≥60 years with IBD. The aims are to quantify the association between frailty and IBD activity and assess the longitudinal impact of frailty on IBD and treatment-related complications. We have successfully undertaken a pilot study enrolling patients ≥60 years with a confirmed diagnosis of IBD in a cohort designed to study frailty. In this cohort, we will collect demographics, IBD-related information, medications, patient reported outcomes (PROs) as well as disease- specific activity indices. We will assess fatigue, unintentional weight loss and physical function using grip strength, gait speed and a PRO as well administer the vulnerable elders scale (VES). We will repeat these measures 6 and 12 months after a baseline evaluation for longitudinal follow-up. This proposal will be the first prospective study of frailty in older adults with IBD. Positioning a frailty assessment within routine clinical care of IBD patients is pioneering. Characterizing those who are physiologically more fit to withstand immunosuppressive therapies may expand access for effective steroid-sparing, therapies to older adults. For career development, this proposal will facilitate my research in aging-related processes in IBD patients and provide the requisite training to apply principles of geriatrics to IBD. Furthermore, these aims will generate the data needed for a competitive NIA K application to develop a multi-center cohort of older adults with IBD to better understand frailty mechanisms and the utility of a tailored frailty instrument to risk stratify older adults requiring immunosuppression for the treatment of IBD. This path will provide the foundation needed to develop a leading research program with the overarching goal of improving the care of older adults with IBD.