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

项目概要/摘要 到2030年，大多数世界贸易中心（WTC）救援和恢复工作人员（响应者）将年满65岁 并处于与衰老相关的状况和后果的风险中。虽然世贸中心一般反应 队列（WTC-GRC）正在老龄化（2021年的中位年龄为59岁），WTC健康计划（WTCHP）没有 定期收集与衰老有关的综合征的数据。特别是，虚弱是一种常见的老年综合征 其特征是对不良事件的脆弱性增加，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一种WTC特有的脆弱性， 评估工具（即，WTC临床虚弱指数/FI），基于临床上可观察到的体征和症状 在WTCHP监测范围内定期检查老化情况。我们的初步数据显示， WTC-GRC符合WTC Clinical-FI确定的虚弱标准， 年龄、WTC暴露和职业类型（例如，建筑工人的风险较高）。这些发现 强调迫切需要对与老龄化有关的结构化指标进行例行系统评估， WTC-GRC的弱点。此外，我们开始了试点工作，以前瞻性地评估物理措施（例如， 虚弱表型）和虚弱的后果（例如，功能障碍，福尔斯 他们在西奈山临床卓越中心（CCE）接受随访，旨在提高准确性 关于WTC Clinical-FI这些努力为更准确地衡量脆弱性迈出了必要的第一步 在世贸中心的一般反应。因此，本项目的总体目标是进一步开发WTC Clinical-FI 研究虚弱的进展和相关的风险因素以及临床结果，并开始试点虚弱 WTC一般反应者的干预措施。特别是，我们将确定脆弱的轨迹和风险因素 使用WTC-GRC健康监测数据库， 在西奈山CCE采集（目标1）;针对虚弱表型验证WTC Clinical-FI，并确定其 纵向队列中与年龄相关的临床结局（如功能下降和福尔斯）的预测有效性 （目标2）;实施针对可改变风险的多成分干预试点 虚弱因素，如一般应答者子集中的药物使用不当（目标3）。识别 虚弱的可改变的风险因素有可能影响整个WTCHP的老龄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 响应者通过与西奈山的国家认可的老年病和姑息治疗的伙伴关系 计划，包括制定针对世贸组织的未来广泛的多因素预防计划 促进健康老龄化。

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.