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