Promoting healthy aging among WTC responders: Frailty trajectories and intervention strategies

促进世贸中心响应者的健康老龄化：衰弱轨迹和干预策略

• 批准号: 10536312
• 负责人: William W.,MPH, MD Hung
• 金额: $ 59.8万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10536312
• 关键词: Promoting; healthy; aging; among; WTC

Project Summary/Abstract By 2030, the majority of World Trade Center (WTC) rescue and recovery workers (responders) will be aged 65 and over and at risk for aging-related conditions and consequences. Although the WTC General Responder Cohort (WTC-GRC) is aging (median age is 59 in 2021), the WTC Health Program (WTCHP) does not routinely collect data on aging-related syndromes. In particular, frailty is a common geriatric syndrome characterized by increased vulnerability to adverse events including mortality, morbidity, disability and hospitalizations. Recently, our multidisciplinary research team has developed a WTC-specific frailty assessment tool (i.e., WTC Clinical Frailty Index/FI) based on clinically observable signs and symptoms of aging regularly examined within WTCHP surveillance. Our preliminary data indicate that approximately 30% of the WTC-GRC meets criteria for frailty as determined by WTC Clinical-FI, an association that increases with age, WTC exposure, and by occupation type (e.g., higher risk among construction worker). These findings underscore the urgent need for routine systematic assessments of structured aging-related indicators such as frailty in the WTC-GRC. Moreover, we began pilot work to prospectively assess physical measures (e.g., Frailty Phenotype) and consequences of frailty (e.g., functional impairment, falls) in WTC general responders who are followed at the Mount Sinai Clinical Center of Excellence (CCE) with an aim to improve the accuracy of the WTC Clinical-FI. These efforts have provided the necessary first step to more accurately measure frailty in WTC general responders. Thus, the overarching goals of this project are to further develop WTC Clinical-FI to study frailty progression and associated risk factors and clinical outcomes, and begin piloting frailty interventions in WTC general responders. Specially, we will determine frailty trajectories and risk factors associated with these distinct trajectories using the repository of WTC-GRC health monitoring data already collected at the Mount Sinai CCE (Aim 1); validate WTC Clinical-FI against Frailty Phenotype and determine its predictive validity for aging-related clinical outcomes such as functional decline and falls in a longitudinal cohort of general responders (Aim 2); and implement a pilot multicomponent intervention targeting modifiable risk factors of frailty such as inappropriate medication use in a subset of general responders (Aim 3). Identifying modifiable risk factors for frailty has the potential to impact the aging WTC responders of the entire WTCHP. Results of this study will be instrumental in improving the capacity of WTCHP to monitor and care for aging responders through partnership with Mount Sinai's nationally recognized Geriatrics and Palliative Care programs including the development of future widespread multifactorial preventive programs tailored to WTC responders to promote healthy aging.

项目概要/摘要 到 2030 年，大多数世贸中心 (WTC) 救援和恢复人员（救援人员）将年龄在 65 岁 并面临与衰老相关的状况和后果的风险。尽管世贸中心总响应员 队列 (WTC-GRC) 正在老龄化（2021 年中位年龄为 59 岁），WTC 健康计划 (WTCHP) 没有 定期收集与衰老相关综合征的数据。特别是，衰弱是一种常见的老年综合症 其特点是更容易遭受不利事件的影响，包括死亡率、发病率、残疾和 住院治疗。最近，我们的多学科研究团队开发了 WTC 特有的脆弱性 基于临床可观察到的体征和症状的评估工具（即 WTC 临床衰弱指数/FI） 在 WTCHP 监测中定期检查老化情况。我们的初步数据表明，大约 30% WTC-GRC 符合 WTC Clinical-FI 确定的虚弱标准，该关联随着时间的推移而增加 年龄、世贸中心暴露情况以及职业类型（例如建筑工人的风险较高）。这些发现 强调迫切需要对结构化的老龄化相关指标进行例行系统评估，例如 WTC-GRC 的脆弱性。此外，我们开始了试点工作，前瞻性地评估物理指标（例如， WTC 一般应答者的虚弱表型）和虚弱后果（例如功能障碍、跌倒） 他们在西奈山临床卓越中心 (CCE) 接受跟踪，旨在提高准确性 世贸中心临床-FI。这些努力为更准确地测量脆弱性提供了必要的第一步 在世贸中心一般响应者中。因此，该项目的总体目标是进一步开发 WTC Clinical-FI 研究衰弱进展以及相关的风险因素和临床结果，并开始试点衰弱 对世贸中心一般响应者的干预。特别是，我们将确定衰弱轨迹和风险因素 已经使用 WTC-GRC 健康监测数据存储库与这些不同的轨迹相关联 在西奈山 CCE 收集（目标 1）；针对虚弱表型验证 WTC Clinical-FI 并确定其 纵向队列中与衰老相关的临床结果（例如功能衰退和跌倒）的预测有效性 一般响应者（目标 2）；并实施针对可改变风险的试点多成分干预措施 虚弱因素，例如部分一般缓解者的药物使用不当（目标 3）。识别 可改变的虚弱风险因素有可能影响整个 WTCHP 中老龄化的 WTC 响应者。 这项研究的结果将有助于提高 WTCHP 监测和护理老龄化的能力 通过与西奈山国家认可的老年病学和姑息治疗中心合作，为急救人员提供帮助 计划，包括制定针对世贸中心的未来广泛的多因素预防计划 响应者促进健康老龄化。