Early Frailty Biomarkers: Patterns of Activity and Energy Expenditure

早期衰弱生物标志物：活动模式和能量消耗

• 批准号: 10400496
• 负责人: Megan J Huisingh-Scheetz
• 金额: $ 14.48万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10400496
• 关键词: Accelerometer; Acute; Address; Adult; Aging; American; Area; Award; Beds; Biological Markers; Body Weight decreased; C-reactive protein; Caring; Cellular Phone; Clinic; Clinical; Clinical Investigator; Clinical Trials Design; Cognition; Complex; Data; Data Set; Detection; Diagnosis; Elderly; Energy Metabolism; Epidemiology; Evaluation; Exhibits; Foundations; Frail Elderly; Functional disorder; Future; Gait speed; Goals; Guidelines; Health; Health Services Accessibility; Health Status; Healthcare; Hospitals; Individual; Institutionalization; Intervention; Intervention Trial; Knowledge; Life; Light Exercise; Longitudinal Surveys; Measures; Mental Depression; Mentorship; Minority; Monitor; Operative Surgical Procedures; Outcome; Outcome Measure; Output; Patient Self-Report; Patients; Pattern; Personal Satisfaction; Physical activity; Physiological; Population; Prevalence; Public Health; Recommendation; Research; Research Personnel; Resources; Risk; Risk Behaviors; Risk Factors; Role; Safety; Sampling; Scientist; Subgroup; Syndrome; Technology; Testing; Time; Training; Translating; Work; Wrist; Writing; base; clinical risk; clinical trial analysis; cohort; design; disability; exercise intervention; exhaustion; experience; frailty; high risk; hospital readmission; improved; individualized medicine; insight; instrumental activity of daily living; interest; mortality; older patient; public health relevance; sedentary lifestyle; social; social engagement; statistics; success; surgical risk; tool; trend

PROJECT SUMMARY / ABSTRACT By 2050, the American population will consist of 88.5 million older adults with a rising prevalence of frailty. Frailty identifies those with diminished physiologic reserve and is increasingly being used to recognize individuals at high risk of rehospitalization, surgical mortality, and health care resource utilization. As a geriatrician with advanced training in Epidemiology, I struggle daily to care for complex, frail patients and recognize the need for accurate tools to quantify frailty risk, trend progression, and to, importantly, guide interventions. Low self-reported physical activity participation is part of the clinical frailty syndrome, yet self- report fails to adequately identify those exhibiting this criterion in their daily lives due to inherent biases. Relying on self-report alone risks under-identifying high-risk individuals and limiting our ability to address this potentially modifiable component. Very little is known about how patterns of activity and sedentary behavior measured by objective monitoring are related to frailty-associated outcomes and how these measures can be applied clinically to predict frailty progression and to guide individualized treatment. My immediate goal and the objective of this proposal is to study how measures of (in)activity relate to frailty and aging outcomes and how they can be used to inform a frailty intervention. I hypothesize that unique, identifiable patterns of (in)activity as measured by activity monitors will predict those who go on to experience a decline in their frailty and aging measures and can be used to tailor treatment recommendations. To test these hypotheses, the following aims are proposed: Aim 1) Characterize activity and sedentary behavior among non-frail, pre-frail, and frail subgroups using activity monitors and relate these measures to 5-year frailty and aging outcomes; Aim 2) In my independent, longitudinal frailty study, relate activity, sedentary behavior, sit-to-stand transitions and cadence to change in frailty components and aging outcomes at 1-year; and Aim 3) Design and pilot test a frailty intervention tool that addresses activity barriers among frail adults and tailors activity targets for frail individuals using identified accelerometry deficits. I will relate activity monitor output from the National Social Life, Health and Aging Project data (2010-2011, 2015-2016) to frailty and aging outcomes at 5 years. I will then translate these findings in my established clinical cohort (Successful Aging and Frailty Evaluation clinic) of predominantly pre-frail and frail adults using activity monitoring and 1-year outcomes. Finally, I will use the findings from these studies in combination with patient and professional stakeholder input to design a sustainable intervention appropriate for frail elders. These proposed studies will identify modifiable activity and sedentary behaviors that can be measured using activity monitoring to detect frailty risk factors, predict progression, and guide treatment, and thus advance our understanding of the role of activity and sedentary behavior in the pathophysiology and treatment of frailty. During the award period, I will receive critical mentorship from nationally-recognized aging researchers, Drs. Linda Waite and William Dale, and supplementary guidance from experts in activity (Dr. Amy Luke), sedentary behavior (Dr. David Conroy), energy expenditure (Dr. Dale Schoeller), frailty (Dr. Jeremy Walston), longitudinal survey and clinical trial analysis (Dr. Masha Kocherginsky), and interventional trials in older adults (Dr. Lee Lindquist). I will obtain advanced training in frailty, activity monitoring, statistics, clinical trial design, and writing. This work will lay the foundation for my long-term goal of becoming an independent clinical investigator with expertise in the diagnosis and management of frailty.

项目总结/摘要 到2050年，美国人口将由8850万老年人组成，虚弱的患病率将上升。 虚弱是指那些生理储备减少的人， 再住院、手术死亡率和卫生保健资源利用率高风险的个体。作为 作为一名接受过流行病学高级培训的老年病学家，我每天都在努力照顾复杂、虚弱的病人， 认识到需要准确的工具来量化虚弱风险、趋势进展，重要的是， 干预措施。自我报告的身体活动参与率低是临床虚弱综合征的一部分，但自我报告的身体活动参与率低是临床虚弱综合征的一部分。 由于固有的偏见，报告未能充分确定在日常生活中表现出这一标准的人。 仅仅依靠自我报告可能会低估高风险个体，并限制我们解决这一问题的能力 潜在的可修改组件。人们对活动模式和久坐行为 与虚弱相关的结果有关，以及这些措施如何 临床上用于预测虚弱进展和指导个体化治疗。我的近期目标和 本提案的目的是研究活动（不活动）的测量如何与虚弱和老龄化结果相关， 如何使用它们为脆弱干预提供信息。我假设，独特的，可识别的模式， 活动监测器测量的活动量将预测那些继续经历虚弱下降的人 和老化措施，并可用于定制治疗建议。为了验证这些假设， 提出了以下目的：目的1）表征非虚弱，虚弱前期， 和虚弱亚组使用活动监测，并将这些措施与5年的虚弱和老龄化的结果; 目标2）在我的独立、纵向虚弱研究中，涉及活动、久坐行为、坐到站的过渡 和节奏，以改变脆弱的组成部分和老化结果在1年;和目标3）设计和试点测试a 脆弱干预工具，解决脆弱成年人的活动障碍，并为脆弱的人量身定制活动目标 使用已识别的加速度计缺陷的个体。我将把活动监测器输出与国家社会 生命、健康和老龄化项目数据（2010-2011年，2015-2016年）与5年时的虚弱和老龄化结局。我会 然后在我建立的临床队列（成功衰老和虚弱评估诊所）中翻译这些发现， 主要是虚弱前和虚弱的成年人使用活动监测和1年的结果。最后，我将使用 这些研究的结果与患者和专业利益相关者的投入相结合， 适合体弱长者的可持续干预措施。这些拟议的研究将确定可改变的活动， 可以使用活动监测来测量久坐行为，以检测虚弱风险因素，预测 进展，并指导治疗，从而推进我们对活动和久坐的作用的理解 病理生理学和虚弱治疗中的行为。在获奖期间，我将收到关键的 来自全国公认的老龄化研究人员，博士指导琳达韦特和威廉戴尔， 活动专家（艾米·卢克博士）、久坐行为专家（大卫·康罗伊博士）、 能量消耗（Dale Schoeller博士），虚弱（Jeremy Walston博士），纵向调查和临床试验 分析（Masha Kocherginsky博士）和老年人干预性试验（Lee Lindquist博士）。我会得到 在虚弱，活动监测，统计，临床试验设计和写作方面的高级培训。这项工作将奠定 我的长期目标是成为一名独立的临床研究者， 虚弱的诊断和管理。