Frailty in Inflammatory Bowel Diseases

炎症性肠病导致的虚弱

• 批准号: 10302530
• 负责人: Bharati Kochar
• 金额: $ 16.8万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-15 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10302530
• 关键词: Adult; Affect; Age; Aging; American; Award; Biological; Body Weight decreased; Caring; Chronic; Chronic Disease; Chronology; Code; Communities; Crohn' s disease; Data; Decision Making; Diagnosis; Disease; Disease Management; Disease Progression; Disease remission; Elderly; Elements; Encapsulated; Enrollment; Evaluation; Fatigue; Foundations; Frail Elderly; Functional disorder; Gait speed; Gastrointestinal tract structure; Geriatrics; Goals; Hand Strength; Hand functions; Health Status; Hip Fractures; Immunosuppression; Incidence; Infection; Inflammaging; Inflammation; Inflammatory; Inflammatory Bowel Diseases; Intervention; Life; Literature; Liver diseases; Longitudinal cohort; Malignant Neoplasms; Measures; Morbidity - disease rate; Operative Surgical Procedures; Osteoporosis; Outcome; Patient Outcomes Assessments; Patients; Pharmaceutical Preparations; Phenotype; Physical Function; Physiological; Pilot Projects; Play; Polypharmacy; Population Decreases; Positioning Attribute; Prevalence; Process; Prospective Studies; Prospective cohort; Publishing; Relapse; Research; Retrospective Studies; Risk; Risk Estimate; Role; Safety; Steroids; Syndrome; Therapeutic immunosuppression; Time; Training; Treatment Efficacy; Ulcerative Colitis; Work; aging population; career development; clinical care; clinical practice; cohort; demographics; design; effective therapy; experience; falls; follow-up; frailty; functional status; grasp; high risk; improved; indexing; innovation; instrument; loss of function; mortality; older patient; outcome prediction; patient stratification; programs; risk stratification; sex; young adult

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.

项目概要和摘要 炎症性肠病 (IBD)，包括克罗恩病 (CD) 和溃疡性结肠炎 (UC)，是一种慢性疾病 影响超过 300 万美国人的胃肠道 (GI) 炎症。 IBD 传统上是 年轻人的疾病，但 IBD 具有双峰发病率，第二个高峰出现在生命的 7 岁左右。 人口老龄化、死亡率下降以及发病率和患病率上升导致了显着的 患有 IBD 的老年人数量增加：26% 患有 IBD 的美国人年龄≥65 岁。 IBD 患者患有老年病 早年出现的综合症。然而，与衰老相关的结构（例如虚弱）对 IBD 活动的影响和 并发症未知。在回顾性研究中，与虚弱相关的诊断代码在 IBD 中更为普遍 患者，免疫抑制后感染几率增加近两倍，而免疫抑制后感染几率增加近三倍 死亡率。与年轻人相比，患有 IBD 的老年人的疾病和治疗相关结果较差 成年人。衰弱构建已成功用于对癌症和晚期肝癌患者进行风险分层 疾病。确定虚弱与 IBD 活动和并发症的关系对于全面治疗至关重要 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。目标是 该提案旨在使用 Fried 衰弱表型来表征 60 岁以上患有 IBD 的成人的衰弱特征。目标 旨在量化虚弱与 IBD 活动之间的关联，并评估虚弱对 IBD 活动的纵向影响 IBD 和治疗相关的并发症。我们已经成功开展了一项试点研究，招募了 ≥60 名患者 在一个旨在研究虚弱的队列中，确诊患有 IBD 多年。在这个队列中，我们将收集 人口统计数据、IBD 相关信息、药物、患者报告结果 (PRO) 以及疾病 具体活动指数。我们将使用握力来评估疲劳、无意的体重减轻和身体功能 力量、步态速度和 PRO 以及弱势老年人量表 (VES)。我们将重复这些 纵向随访基线评估后 6 个月和 12 个月进行测量。该提案将是第一个 患有 IBD 的老年人虚弱的前瞻性研究。将衰弱评估纳入常规临床护理中 IBD 患者是先锋。描述那些生理上更适合承受的人 免疫抑制疗法可能会扩大老年人获得有效类固醇节省疗法的机会。为了 职业发展，该提案将促进我对 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 竞争性 NIA K 应用程序所需的数据，用于开发患有 IBD 的老年人的多中心队列，以更好地 了解衰弱机制以及定制衰弱工具的实用性，以对需要的老年人进行风险分层 免疫抑制用于治疗IBD。这条道路将为发展领先的 研究计划的总体目标是改善患有 IBD 的老年人的护理。