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.”

项目摘要和摘要 这是Bharati Kochar，MD，MS的Beeson（K76）新兴领导者， 专门研究炎症性肠道疾病（IBD）的医师治疗剂和胃肠病学家 为了增长但已理解的胃肠病学的人群，推进护理的术语目标是 状况。虽然IBD传统上遭受了年轻人的困扰，但成年人≥60岁是增长最快的年龄段 IBD和至少25％的门诊患者人口。但是，老年人完成<1％ IBD临床试验中的患者。免疫抑制疗法不断扩大的武器库包括 感染和血小板事件，所有这些事件在老年人中更频繁地发生。该提议解决了 迫切需要生成有关IBD治疗安全性，有效性和适用于老年人的高质量数据 优化并有效量身定制治疗。初步数据表明，脆弱的 缺乏和作为表型的积累是IBD中相关的构造。但是， IBD老年人的脆弱，功能，类型和对IBD治疗的反应和不良事件尚不清楚。 该提案的目的是研究脆弱的组成部分，并在预测不良影响方面的功能 在老年人中进行IBD治疗。具体目的是（1）回顾性确定的差异增加 成人IBD治疗类别的启动者之间与脆弱指数相关的广告事件的风险 ≥60岁，（2）前瞻性地描绘出对成人IBD治疗的表型脆弱的轨迹 ≥60岁。这些目标的数据将告知（AIM 3A）衍生的老年广告事件风险 预测模型以识别具有最大感染，住院和担心风险最大的IBD的老年人 通过IBD处理的类型自我报告的功能。该提案将通过（AIM 3B）评估可行性来达到最终形式 在临床实践中进行IBD特异性，老年信息的评估。这些目标将导致 老年原则的首次系统应用指导IBD老年人的管理并进行 独立调查计划的基础。 Kochar博士将在指导的指导下实现这些目标 一个非凡的跨学科国际著名的Mentalship团队和国家咨询团队 领导者。主要导师克里斯汀·里奇（Christine Ritchie）博士是老年医生患者复杂性的专家，安德鲁·陈（Andrew Chan）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，应用和经验丰富的高级培训 竞争风险和预测建模，老化研究，包括脆弱和功能方面的专业知识，设计 患者决策援助和领导力发展。无与伦比的精通，深入培训的结合 有意义的研究旨在使她的导师的专业知识的交集为Kochar博士的基础奠定了基础 开发独立调查的途径。这项工作将使Kochar博士成为 老年医学与胃肠病学的交集，并发展了一个新的“老年胃肠病学”领域。