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.”

项目概要和摘要 这是 Beeson (K76) 老年职业发展新兴领导者奖，授予 Bharati Kochar，医学博士、理学硕士、 长期从事炎症性肠病 (IBD) 领域研究的医师兼研究员和胃肠病学家 长期目标是促进对不断增长但尚未充分研究的患有胃肠病的老年人口的护理 虽然 IBD 传统上困扰年轻人，但 60 岁以上的成年人是增长最快的年龄组。 患有 IBD 的患者至少占门诊患者群体的 25%，然而，老年人的比例<1%。 IBD 临床试验中的患者数量不断扩大，其中包括以下风险： 感染和血栓事件，所有这些都在老年人中更常见。该提案解决了这一问题。 迫切需要生成有关 IBD 治疗安全性、有效性和对老年人的适用性的高质量数据 初步数据显示，虚弱程度可以作为一个指标进行衡量。 缺陷的积累和作为一种表型，是 IBD 中的一个相关结构。 患有 IBD 的老年人的虚弱、功能、类型和对 IBD 治疗的反应以及不良事件尚不清楚。 该提案的目标是研究虚弱的组成部分和预测不利影响的功能 老年人 IBD 治疗的具体目的是 (1) 回顾性确定差异增加。 成人 IBD 治疗起始者中与虚弱指数相关的不良事件的风险 ≥60 岁和 (2) 通过成人对 IBD 治疗的反应前瞻性地描绘表型衰弱的轨迹 ≥60 岁。这些目标的数据将指导（目标 3a）推导老年知情的不良事件风险。 预测模型可识别患有 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。 在临床实践中进行针对 IBD 的、针对老年人的评估这些目标将导致以下结果： 首次系统地应用老年学原理来指导患有 IBD 的老年人的管理，并奠定了 科查尔博士将在独立调查计划的基金会的指导下实现这些目标。 卓越的跨学科国际知名导师团队和国家顾问团队 首席导师 Christine Ritchie 博士是老年医学患者复杂性方面的专家，Andrew Chan 博士是 Ashwin Ananthakrishnan 博士是慢性病和结肠癌流行病学专家，Ashwin Ananthakrishnan 博士是 IBD 患者 该奖项还支持高级结构化教学、应用和体验式培训。 竞争风险和预测模型、衰老研究（包括虚弱和功能方面的专业知识）、设计 耐心决策援助和领导力发展的结合无与伦比的指导和深入培训。 旨在融合导师专业知识的有意义的研究为 Kochar 博士奠定了基础 这项工作将使科查尔博士成为该领域的领导者。 老年病学和胃肠病学的交叉点，并开发了“老年胃肠病学”的新领域。