Optimal Preoperative Care for Older Adults with Inflammatory Bowel Disease (K76) - Resubmission - 1
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ABSTRACT Adults 60 years and older are the fastest growing subpopulation of patients with inflammatory bowel disease (IBD), and are soon forecasted to represent >1 million individuals living in the U.S with IBD. The mainstay of therapy for older adults with IBD is biologic therapy, but when these agents fail, surgery is required. Overall, despite the growing armamentarium of biologic therapies, more than 20% of older adults with IBD will ultimately require surgery. Further, surgical emergency and complication rates among older adults with IBD are twice as high as compared to younger adults with IBD, with mortality rates reported as ten-fold higher. This, in part, is due to an initial deferral of surgery, given the higher perceived risk of an adverse operative outcome associated with increasing chronological age. Paradoxically, however, this delay can contribute to the heightened surgical risk observed by increasing time on corticosteroids, and by leading to prolonged periods of inflammation and malnutrition, which can precipitate physiologic and cognitive decline among older adults. In order to shift the age-old practice of deferring surgical treatment due to chronological age alone, we aim to address three critical knowledge gaps in the field: (1) Derive and validate a model predicting which older adults with IBD will ultimately require disease-related surgery; (2) Derive a preoperative model predicting risk of a major adverse postoperative event (we will include measures of sarcopenia, cognition, and malnutrition); and (3) Identify patient and clinician barriers that contribute to surgical delays among older adults with IBD. In order to complete this work, we have developed a mentorship team that has complementary expertise in aging- related research, geriatric and surgical care, risk modeling, qualitative analyses, decision support, and career development. This team, coupled with the rich environment in which this work will be completed, will help the candidate meet his career goals: (1) Develop expertise in aging-related research and geriatric care; (2) Learn advanced statistical modeling; (3) Obtain formal training in qualitative and mixed methods analysis; and (4) Apply for and obtain R01 grant funding. In all, by identifying who is likely to need surgery, what preoperative factors contribute to the risk of surgical complications, and which barriers exist for surgical care among older adults with IBD, we can shift current practice and reduce delays when surgery is required. This can improve outcomes for thousands of older adults with IBD, and help identify avenues for future intervention.
