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.

项目摘要/摘要 到2030年，世界贸易中心（WTC）的大多数救援人员（响应者）将年满65岁 以及与衰老有关的疾病和后果的风险。虽然WTC一般响应者 队列（WTC-GRC）是衰老（中位年龄为2021年），WTC健康计划（WTCHP）没有 通常收集有关衰老综合征的数据。特别是，脆弱是一种常见的老年综合症 其特征是增加对不良事件的脆弱性，包括死亡率，发病率，残疾和 住院。最近，我们的多学科研究团队开发了特定的WTC特定脆弱性 评估工具（即WTC临床脆弱指数/FI）基于临床上可观察到的体征和症状 在WTCHP监视中定期检查老化。我们的初步数据表明约有30％ WTC-GRC符合WTC Clinical-Fi确定的脆弱标准，该关联与 年龄，WTC暴露和按职业类型（例如，建筑工人的风险更高）。这些发现 强调了迫切需要对结构化衰老相关指标的常规系统评估 WTC-GRC中的脆弱。此外，我们开始进行试点工作，以评估身体措施（例如， WTC一般响应者中脆弱的表型）和脆弱的后果（例如功能障碍，跌落） 在西奈山临床卓越中心（CCE）中跟随的，目的是提高准确性 WTC临床fi。这些努力提供了必要的第一步，以更准确地衡量脆弱 在WTC总响应者中。因此，该项目的总体目标是进一步发展WTC临床网络 研究脆弱的进展以及相关的危险因素和临床结果，并开始尝试脆弱 WTC总响应者的干预措施。特别是，我们将确定脆弱的轨迹和风险因素 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（AIM 1）收集；验证WTC临床FI针对脆弱的表型，并确定其 与衰老相关的临床结果的预测有效性，例如功能下降和纵向队列中的下降 一般响应者（目标2）；并实施针对可修改风险的飞行员多组分干预措施 脆弱的因素，例如在一部分全响应者中使用不适当的药物使用（AIM 3）。识别 脆弱的可修改风险因素有可能影响整个WTCHP的老化WTC响应者。 这项研究的结果将有助于提高WTCHP监测和护理衰老的能力 通过与西奈山（Mount Sinai）全国认可的老年医学和姑息治疗的合作伙伴关系 程序包括开发未来广泛的多因素预防计划，适用于WTC 响应者促进健康的衰老。