NHS Lothian

N/A

DL-2022-045

Inflammatory bowel disease (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), is a condition in which the gastrointestinal immune system responds inappropriately. It is therefore often treated with immune suppression medications to control inflammation and to prevent ‘flares’, a worsening in symptoms, which may be unpredictable. Frailty is a description of the process in which the body loses its reserves. It generally increases with age. Frailty can be associated with many health outcomes and affect how diseases progress. Currently, there is limited research into how frailty interacts with inflammatory bowel disease. Therefore, we hope to measure frailty in a standardised scale and understand whether frailty affects outcomes in inflammatory bowel disease, and how patients react to treatment such as advanced biologic medications and surgery. By understanding these patterns, we can take into account frailty when tailoring treatment pathways in these patients within NHS Lothian.

he electronic frailty index (eFI) is the only validated routine data frailty measure that is incorporated into direct clinical care in the UK. It was first developed in a retrospective observational study of 415k patients aged 65-95 years old with linked GP records in the ResearchOne database and validated in 516k patient records in the THIN GP database1. Both data sources are based in England. The eFI comprises 36 binary health ‘deficits’ that are derived from up to 2,000 possible Read codes (entered in GP systems reflecting individual patient codes for disease, functional status, prescriptions, test results and more). The deficits are combined in an unweighted score, with thresholds applied for fit (0–0.12), mild frailty (0.13–0.24), moderate frailty (0.25–0.36) and severe frailty (>0.36). Although this loses information from the continuous eFI measure, these thresholds have become clinically meaningful in determining proposed medical interventions and are embedded into clinical guidelines for interpretation of the eFI. The score was shown to be associated with mortality, unplanned hospital admission and transition into a care home at 1, 3 and 5 years with evidence of a dose response with the degree of frailty. The eFI has been adopted directly into GP electronic health record systems and use of the tool for the proactive assessment of older people is part of the NHS England GP contract. IBD diagnosed in the elderly population is known to have a distinct disease profile from those diagnosed at a younger age. Recently, there is an increasing attention in the literature regarding the interactions between IBD and frailty2. It has also been shown that patients with IBD have a higher prevalence of frailty compared to matched non-IBD population (12 vs 6%)3. There is however limited data on the impact of frailty on mortality, hospital admissions and therapy related side effects in IBD. A study in 2019 identified around 10,500 cases of IBD in Lothian, over 1% of people aged over 50, with cases increasing over the last 10 years. With a growing elderly population, it is becoming increasingly important to risk stratify individuals to clinical care that proves beneficial and minimises harm. By characterising IBD patients based on their frailty index, we hope to evaluate their treatment outcome and investigate how frailty can be taken into account when designing treatment guidelines and management decisions, thereby providing cost-effective care.

Public Health Research

22/07/2024

De-Personalised

TRE