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

项目摘要和摘要 这是Beeson(K76)颁发给Bharati Kochar的新兴老龄化领导者职业发展奖 专攻炎症性肠病(IBD)的内科医生、研究员和胃肠病专家 推进对不断增长但未得到充分研究的胃肠病老年人口的护理的长期目标 条件。虽然炎症性肠病传统上困扰着年轻人，但60岁的成年人≥是增长最快的年龄段 患有IBD，至少占门诊患者人口的25%。然而，老年人占1%。 在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 感染和血栓事件，所有这些都更多地发生在老年人身上。这项建议解决了 迫切需要生成有关老年人IBD治疗的安全性、有效性和适用性的高质量数据 优化和有效地量身定制治疗方法。初步数据显示，脆弱程度，以 缺陷的累积和作为一种表型，是IBD的一个相关结构。然而，两国之间的关系 IBD老年患者的虚弱、功能、类型和对IBD治疗和不良事件的反应尚不清楚。 这项建议的目的是调查在预测不良影响方面的脆弱性和功能的组成部分。 对老年人进行IBD治疗。具体目标是：(1)回溯确定差异增加 成人IBD治疗类别发起者中与脆弱指数相关的不良事件的风险 ≥60年和(2)通过对成人IBD治疗的反应来前瞻性地描绘表型脆弱的轨迹 ≥60岁。来自这些目标的数据将告知(目标3a)老年人知情不良事件风险的来源 预测模型确定患有IBD的老年人感染、住院和病情恶化的最大风险 按IBD治疗类型进行自我报告功能。该提案的最终结果是(目标3b)评估可行性。 在临床实践中进行针对IBD的、老年人知情的评估。这些目标将导致 首次系统地应用老年学原理指导老年人IBD的治疗并奠定了 一项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 一支卓越的跨学科的国际知名导师团队和咨询团队 领袖们。初级导师Christine Ritchie博士是老年病患者复杂性方面的专家，Andrew Chan博士 是慢性病和结肠癌流行病学方面的专家，Ashwin Ananthakrishnan博士是IBD 思想领袖。该奖项还支持高级培训中的结构化教学、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 耐心的决策辅助和领导力的发展。无与伦比的导师与深度培训的结合 而旨在将导师的专业知识交叉的有意义的研究为科查尔博士奠定了基础 开发一条独立调查的途径。这项工作将使科查尔博士成为 将老年病学和胃肠病学结合起来，开辟“老年胃肠病学”的新领域。

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.”