The PREDICT Study (PRE-ICU Determinants of Post-ICU FunCTional Outcomes among Older Adults)

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Project Abstract of the Parent Grant: The PREDICT study Candidate: My career goal is to become an independent physician-scientist and national leader in geriatric critical care outcomes research whose body of work improves the long-term functional outcomes of critically ill older adults. My clinical training as a Pulmonary & Critical Care Medicine (PCCM) physician and research training in Geriatric Clinical Epidemiology have prepared me to pursue this career path. My track record of early success is evidenced by the publication of high-impact original reports and the receipt of 3 grants, including a GEMSSTAR award. I have already distinguished myself as a national leader in my specialty as well as in geriatrics: I founded and am co-chair of the American Thoracic Society Critical Care Assembly's Aging and Geriatrics Working Group, and was recently selected as an incoming co-chair of the American Geriatrics Society (AGS) Medical Subspecialties Section. My research efforts have been recognized nationally, with the AGS New Investigator Award, and at Yale, with the prestigious Iva Dostanic Physician-Scientist Award. Mentors and Environment: I have an exceptional team of mentors and advisors, including my primary mentor Dr. Thomas Gill (Geriatrics), a leading expert on the epidemiology and prevention of disability, co-mentor Dr. Margaret Pisani (PCCM), an expert in critical care outcomes research, and advisor Dr. Terrence Murphy, a biostatistician with expertise in longitudinal studies of aging. My research and career development plans draw on the wealth of resources available at Yale, including the Yale Claude D. Pepper Older Americans Independence Center, the Yale School of Public Health, and one of the largest intensive care units (ICUs) in the country at Yale-New Haven Hospital. These resources, and the support provided by the Yale School of Medicine, provide an ideal environment for my career development and execution of the proposed research. Mentored Research Project: Nearly 1.4 million older adults survive an ICU stay each year, and many of these will suffer from increased disability. Our prior work has demonstrated that premorbid factors are strongly associated with the course of disability after a critical illness -- yet no mechanism exists to identify which older ICU patients are at risk of increased disability. To address this knowledge gap, I have proposed an innovative research project that leverages the wealth of resources available at Yale in addition to two high-quality longitudinal datasets: the National Health and Aging Trends Study (NHATS) and Precipitating Events Project (PEP). The overall objective is to develop, externally validate, and pilot test a predictive tool (that incorporates premorbid risk factors) to identify older ICU patients at risk of worsening post-ICU disability and provide a personal estimate of the increase in disability. The results will inform the design and conduct of a larger prospective cohort study to test the accuracy of the tool in predicting post-ICU disability as well as a subsequent clinical trial testing interventions to improve post-ICU functional outcomes among older adults.