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.

项目摘要和摘要 由克罗恩病（CD）和溃疡性结肠炎（UC）组成的炎症性肠病（IBD）是慢性 胃肠道（GI）的炎症状况影响超过300万美国人。 IBD传统上是 年轻人的疾病，但IBD有双峰事件，第二个高峰发生在生命的第7个十年中。 人口老龄化，死亡人数减少以及发病率和流行率的升高导致了突出的 IBD的老年人的增加：26％的IBD美国人≥65岁。 IBD患者有老年病 早期综合征。然而 并发症未知。在回顾性研究中，IBD中与脆弱的诊断代码更为普遍 患者，免疫抑制后几乎是感染几乎两倍，几乎是三倍的几率 死亡率。与年轻人相比 成年人。脆弱的结构已成功地用于使患有癌症和终阶段肝脏的患者分层 疾病。确定脆弱性与IBD活动和并发症的关系对于全面而言至关重要 评估老年人，并将接受IBD治疗免疫抑制的老年患者分层。目标 该建议是使用炸脆弱的表型来表征IBD≥60岁的成年人的脆弱。目的 是要量化脆弱活动与IBD活动之间的关联，并评估脆弱的纵向影响 IBD和与治疗有关的并发症。我们已经成功地进行了一项试验研究，该研究招募了≥60的患者 在旨在研究脆弱的队列中确认了IBD的确认诊断。在这个队列中，我们将收集 人口统计学，IBD相关信息，药物，患者报告的结果（PRO）以及疾病 - 特定的活动指数。我们将使用握把评估疲劳，无意的体重减轻和身体机能 力量，获得速度和专业人士以及管理脆弱的长老量表（VES）。我们将重复这些 在基线评估后6和12个月进行纵向随访。该提议将是第一个 IBD老年人对脆弱的前瞻性研究。在常规临床护理中定位脆弱的评估 IBD患者正在开创性。表征那些身体更适合承受的人 免疫抑制疗法可能会扩大有效的类固醇疗法，疗法的机会。为了 职业发展，这项建议将促进我在IBD患者与衰老相关的过程中的研究 提供必要的培训将老年医学原则应用于IBD。此外，这些目标将产生 竞争性的NIA K应用所需的数据，以开发具有IBD的老年人的多中心队列 了解脆弱的机制和量身定制的脆弱仪器的实用性，以使需要分层的老年人进行分层 用于治疗IBD的免疫抑制。这条道路将为发展领先所需的基础 研究计划的总体目标是改善IBD的老年人护理。