Incorporating Geriatric Constructs into Management of Inflammatory Bowel Diseases in Older Adults

将老年结构纳入老年人炎症性肠病的治疗

• 批准号: 10729893
• 负责人: Bharati Kochar
• 金额: $ 24.3万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10729893
• 关键词: Address; Adult; Adverse effects; Adverse event; Advisory Committees; Aftercare; Age; Aging; American; Award; Benefits and Risks; Cardiovascular system; Caring; Categories; Chronic Disease; Chronology; Clinical Trials; Colon Carcinoma; Cox Models; Data; Decision Aid; Derivation procedure; Diagnosis; Discrimination; Effectiveness; Elderly; Electronic Health Record; Event; Foundations; Funding; Future; Gastroenterologist; Gastroenterology; Geriatrics; Goals; Hospitalization; Immunosuppression; Immunosuppressive Agents; Infection; Inflammatory; Inflammatory Bowel Diseases; International; Investigation; K-Series Research Career Programs; Learning; Measures; Mediator; Mentors; Mentorship; Modeling; Modernization; Older Population; Online Systems; Operative Surgical Procedures; Outcome; Pathway interactions; Patient Self-Report; Patients; Perception; Pharmaceutical Preparations; Phenotype; Physicians; Population Heterogeneity; Positioning Attribute; Prospective cohort; Research; Research Personnel; Retrospective Studies; Risk; Safety; Steroids; Structure; Testing; Therapeutic; Therapeutic immunosuppression; Time; Training; Validation; Work; Workplace; adverse event risk; adverse outcome; age group; cancer epidemiology; career development; clinical practice; cohort; comorbidity; design; experience; frailty; human old age (65+); improved; indexing; individualized medicine; infection risk; leadership development; mortality; novel; patient population; predictive modeling; primary outcome; programs; prospective; response; risk prediction model; risk stratification; shared decision making; thrombotic; tool; treatment risk; validation studies; young adult

PROJECT SUMMARY AND ABSTRACT This is a Beeson (K76) Emerging Leaders in Aging career development award for Bharati Kochar, MD, MS, a physician-investigator and gastroenterologist specializing in inflammatory bowel diseases (IBD) with the long term goal of advancing care for the growing, but understudied, population of older adults with gastroenterological conditions. While IBD has traditionally afflicted young adults, adults ≥60 years are the fastest growing age group with IBD and comprise at least 25% of the ambulatory patient population. However, older adults comprise <1% of patients in IBD clinical trials. The expanding arsenal of immunosuppressive therapies include risks for infections and thrombotic events, all of which occur more frequently in older adults. This proposal addresses the urgent need to generate high quality data on IBD treatment safety, effectiveness and applicability to older adults to optimize and effectively tailor treatments. Preliminary data revealed that frailty, measured both as an accumulation of deficits and as a phenotype, is a construct pertinent in IBD. However, the relationship between frailty, function, type of and response to IBD treatments and adverse events in older adults with IBD is unknown. The goal of this proposal is to investigate the components of frailty and function in predicting adverse effects with IBD treatments in older adults. The specific aims are to (1) retrospectively determine differential increased risks for adverse events associated with a frailty index among initiators of classes of IBD treatments in adults ≥60 years and (2) prospectively delineate trajectories of phenotypic frailty by response to IBD treatment in adults ≥60 years. Data from these aims will inform (Aim 3a) the derivation a geriatric-informed adverse event risk prediction model to identify older adults with IBD at greatest risk for infections, hospitalizations and worsening self-reported function by type of IBD-treatment. The proposal will culminate by (Aim 3b) assessing the feasibility of conducting an IBD-specific, geriatric-informed, assessment in clinical practice. These aims will result in the first systematic application of geriatric principles to guide management of older adults with IBD and lay the foundation for a program of independent investigation. Dr. Kochar will achieve these aims with the guidance of an exceptional cross-disciplinary internationally renowned mentorship team and advisory team of national leaders. Primary mentor Dr. Christine Ritchie is an expert on patient complexity in geriatrics, Dr. Andrew Chan is an expert in chronic disease and colon cancer epidemiology and Dr. Ashwin Ananthakrishnan is an IBD thought leader. This award also supports structured didactic, applied and experiential training in advanced competing risk and prediction modeling, aging-research including expertise in frailty and function, designing a patient decision aid and leadership development. The combination of unparalleled mentorship, in-depth training and meaningful research aims at the intersection of her mentors’ expertise lays the foundation for Dr. Kochar to develop a pathway to independent investigation. This work will position Dr. Kochar to be a leader at the intersection of geriatrics and gastroenterology and develop a novel field of “Geriatric Gastroenterology.”

项目总结和摘要 这是颁发给Bharati Kochar（医学博士、理学硕士）的Beeson（K76）老龄化职业发展新兴领袖奖 长期从事炎症性肠病（IBD）研究的医生-研究者和胃肠病学家 长期目标是促进对不断增长但研究不足的老年胃肠病患者的护理 条件虽然IBD传统上困扰年轻人，但≥60岁的成年人是增长最快的年龄组 IBD患者，占非卧床患者人群的至少25%。然而，老年人占不到1%， IBD临床试验中的患者。不断扩大的免疫抑制疗法包括以下风险： 感染和血栓形成事件，所有这些都更频繁地发生在老年人中。该提案针对 迫切需要生成关于IBD治疗安全性、有效性和对老年人适用性的高质量数据 来优化和有效地定制治疗方法。初步数据显示，脆弱性，衡量都作为一个 缺陷的积累和作为表型，是IBD中相关的构建体。但是，关系 老年IBD患者的虚弱、功能、类型和对IBD治疗的反应以及不良事件尚不清楚。 这个建议的目的是调查脆弱的组成部分和预测不良反应的功能 老年人IBD的治疗。具体目的是（1）回顾性确定差异增加 成人IBD治疗类别启动者中与虚弱指数相关的不良事件风险 ≥60岁和（2）前瞻性描述成人IBD治疗应答的表型虚弱轨迹 ≥60岁。来自这些目标的数据将为（目标3a）推导老年人知情的不良事件风险提供信息 预测模型，以确定感染，住院和恶化风险最大的IBD老年人 按IBD治疗类型列出的自我报告功能。该提案将通过（目标3b）评估可行性而达到高潮 在临床实践中进行IBD特异性、老年学信息评估。这些目标将导致 首次系统应用老年医学原则指导老年IBD患者的管理， 独立调查计划的基础。Kochar博士将在以下指导下实现这些目标： 一个特殊的跨学科的国际知名的导师团队和咨询团队的国家 领导人的人选信号主要导师克莉丝汀里奇博士是老年病患者复杂性方面的专家，安德鲁陈博士 是慢性病和结肠癌流行病学专家，Ashwin Ananthakrishnan博士是IBD 思想领袖该奖项还支持结构化的教学，应用和体验式培训， 竞争风险和预测建模，老化研究，包括脆弱性和功能方面的专业知识，设计一个 患者决策援助和领导力发展。无与伦比的指导，深入的培训 和有意义的研究旨在交叉她的导师的专业知识奠定了基础博士。 开辟独立调查的途径。这项工作将使Kochar博士成为该领域的领导者。 老年医学与胃肠病学的交叉，开拓“老年胃肠病学”新领域。