Identifying and targeting modifiable inflammatory factors underlying higher risk of frailty in individuals experiencing deprivation

虚弱是公共卫生的一个大问题，在贫困社区尤为普遍。英国公共卫生部关于健康老龄化的共识表示，生活在贫困中的人的健康时间少了20年，而且随着年龄的增长，他们更有可能变得虚弱。无家可归者、吸毒或酗酒者、有学习困难者、需要心理保健者或易受伤害的移徙者更有可能提前变得虚弱。国家卫生研究院为服务不足人群设计和提供临床试验创新（INCLUDE）项目一直在努力寻找将服务不足人群纳入健康和护理研究的方法（https://tinyurl.com/y6k4y9vd）。老年人被指出是一个没有得到足够帮助的群体，他们的观点也总是在老龄化研究中得到充分体现。这项研究建议与老年医学专家最近给出的建议一致。该建议的目标是更好地将服务不足的群体纳入研究，减少不平等现象，并更多地了解影响这些人群的疾病的发病率和死亡率，以便能够制定有效的现实干预措施。他的项目将通过识别和描述与过早虚弱相关的特定炎症途径来解决这一需求，这些炎症途径可以通过针对肠道微生物来改变，然后开发干预措施来减少贫困人群的过早虚弱。该研究旨在开发有效的干预措施，考虑到导致虚弱和衰老的社会和环境因素，首先确定衰老和社会剥夺之间常见的炎症机制，然后关注那些与人携带的肠道微生物有关的机制。这意味着这种机制可以通过饮食或运动来改变肠道微生物群。然后，该团队将使用先进的统计技术和来自英国生物银行数十万人的数据来确定炎症特征在过早衰老和虚弱中的因果作用。利用已经完成的饮食和锻炼临床干预的微生物组和炎症数据，将有可能确定哪些干预措施或干预措施组合最有可能专门解决与早衰导致的剥夺有关的炎症/微生物组途径。通过定性研究干预措施的可行性和可接受性。来自被剥夺权利的个人、护理院里虚弱的人、护理人员和与这些群体合作的慈善机构的观点都将被纳入设计一个原型干预措施。这种整体办法认识到有多种因素可以影响健康结果，并旨在制定适合贫困人口需要的干预措施。该跨学科团队由来自不同领域的专家组成，如临床专家（老年病专家、骨科医生）、社会科学家、生物信息学家、组学专家和试验学家，可以在设计针对肠道微生物组的干预措施和减少贫困人群的过早虚弱方面非常有益。这样一个团队汇集了各种专门知识和技能，共同评估、规划和管理护理，从而能够采取整体办法来处理护理和解决与早衰有关的健康不平等问题。

Frailty is a big problem for public health, and it is especially common in poor communities. The Consensus on Healthy Ageing from Public Health England says that people who live in poverty have 20 fewer years of good health and are more likely to become weak as they age. People who are homeless, addicted to drugs or alcohol, have learning challenges, need mental health care, or are vulnerable migrants are more likely to become frail before they should.The NIHR Innovations in Clinical Trials Design and Delivery for the Underserved (INCLUDE) project has been trying to find ways to include under-served groups in health and care studies (https://tinyurl.com/y6k4y9vd). Older people have been pointed out as a group that doesn't get enough help nor their views are always adequately represented in research about ageing.This research proposal is in line with the advice recently given by experts in Geriatric medicine. The goal of that advice is to improve the inclusion of underserved groups in research, to reduce inequalities, and to learn more about the morbidity and mortality of diseases that affect these populations so that effective, real-world interventions can be developed.The his project will address this need by identifying and characterising the specific inflammatory pathways involved in premature frailty which are modifiable by targeting gut microbes, to then develop interventions to reduce premature frailtyin deprived populations. The study aims to develop effective interventions that consider the social and environmental factors that contribute to frailty and ageing, identifying first on common inflammatory mechanisms between aging and social deprivation, focusing then on those that are linked to the gut microbes carried by a person. This means that such mechanisms may be targeted by diet or exercise which modify the gut microbiome. The team will then use advance statistical techniques and data from hundreds of thousands of people in UK Biobank to ascertain a causal role of the inflammatory features identified on premature ageing and on frailty. Using microbiome and inflammation data from already completed dietary and exercise clinical interventions, it will be possible to determine which interventions or combinations of interventions are most likely to specifically tackle the inflammatory/microbiome pathways involved in premature ageing cause deprivation. The feasibility and acceptability of interventions through qualitative research. The views from deprived individuals, from frail people in care homes, from carers and charities working with these groups will all be incorporated to design a prototype intervention. This holistic approach recognises that there are multiple factors that can impact health outcomes and aims to develop interventions that are tailored to the needs of deprived populations.The interdisciplinary team comprising of experts from various fields such as clinical experts (geriatricians, orthopaedic surgeons), social scientists, bioinformaticians, omics experts, and trialists can be highly beneficial in designing interventions to target the gut microbiome and reduce premature frailty in deprived populations. Such a team brings together a diverse range of expertise and skills to assess, plan, and manage care jointly, enabling a holistic approach to care and to addressing health inequalities with regards to premature ageing.