Frailty in Inflammatory Bowel Diseases

项目摘要和摘要 炎症性肠病(IBD)由克罗恩病(CD)和溃疡性结肠炎(UC)组成，是一种慢性疾病 影响300多万美国人的胃肠道(GI)炎症状况。IBD传统上是一种 该病多见于年轻人，但IBD的发病率呈双峰型，第二个高峰出现在第7个十年。 人口老龄化、死亡率下降以及发病率和流行率的上升导致了突出的 老年炎症性肠病的增加：26%的美国炎症性肠病患者年龄为≥65岁。IBD患者有老年性 年龄较早的综合征。然而，与衰老相关的结构，如虚弱，对IBD活动和 并发症尚不清楚。在回溯性研究中，与脆弱相关的诊断代码在IBD中更为普遍 患者在免疫抑制后感染的几率几乎是前者的两倍，而感染几率是前者的近三倍 死亡的威胁。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。脆弱结构已成功地用于癌症和终末期肝病患者的风险分层 疾病。确定虚弱与IBD活动性和并发症的关系对于全面 评估老年患者并对接受免疫抑制治疗的老年患者进行风险分层。的目标是 这项建议是使用油炸脆弱表型来表征60岁≥炎症性肠病患者的脆弱。目标 是量化脆弱和IBD活动之间的联系，并评估脆弱对 炎症性肠病及治疗相关并发症。我们成功地进行了一项招募Patients≥60的先导性研究 多年来，在一个旨在研究虚弱的队列中，确诊为IBD。在这群人中，我们将收集 人口统计、IBD相关信息、药物、患者报告结果(PRO)以及疾病- 特定活动指数。我们将使用GRIP评估疲劳、意外体重减轻和身体机能 力量、步态速度和专业人士以及管理脆弱老年人量表(VES)。我们将重复这些内容 在基线评估后6个月和12个月进行纵向随访。这项提议将是第一个 老年IBD患者虚弱的前瞻性研究。在常规临床护理中定位脆弱评估 IBD患者具有开拓性。以那些生理上更适合承受的人为特征 免疫抑制疗法可能会扩大老年人获得有效的类固醇节省疗法的机会。为 职业发展，这项建议将有助于我在IBD患者和 提供必要的培训，以便将老年医学原理应用于IBD。此外，这些目标将产生 竞争对手的NIA K应用程序开发多中心的IBD老年人队列所需的数据，以更好地 了解脆弱性机制和量身定制的脆弱性工具的效用，以便对老年人进行风险分层 免疫抑制在IBD治疗中的应用这条道路将提供发展领先的 研究计划，首要目标是改善对患有IBD的老年人的护理。

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.