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

项目摘要/摘要 到2030年，世界贸易中心(WTC)的大部分救援和恢复工作人员(响应者)将达到65岁 过度并面临与衰老相关的状况和后果的风险。尽管WTC的总响应者 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 例行公事地收集与衰老相关的综合症数据。特别是，虚弱是一种常见的老年综合征。 其特点是更容易受到不良事件的影响，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发现了WTC特有的弱点 基于临床可观察到的体征和症状的评估工具(即WTC临床脆弱指数/FI) 在WTCHP监测范围内定期检查衰老情况。我们的初步数据显示，大约30%的 WTC-GRC符合WTC临床-FI确定的脆弱标准，这种关联随着 年龄、WTC暴露和职业类型(例如，建筑工人风险较高)。这些发现 强调迫切需要对下列与老龄化有关的指标进行例行系统评估 WTC-GRC的脆弱性。此外，我们开始了试点工作，以前瞻性地评估物理测量(例如， WTC一般应答者的脆弱表型)和脆弱的后果(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，目的是提高准确性 世界卫生组织临床医学中心。这些努力为更准确地衡量脆弱性提供了必要的第一步。 在世贸中心的一般应答者。因此，该项目的总体目标是进一步发展WTC临床 研究虚弱进展及其相关风险因素和临床结果，并开始试行虚弱 世界旅游中心一般应答者的干预。特别是，我们将确定脆弱轨迹和风险因素 已经使用WTC-GRC健康监测数据的存储库与这些不同的轨迹相关联 在西奈山CCE收集(AIM 1)；验证WTC临床FI针对脆弱表型并确定其 纵向队列中与衰老相关的临床结局的预测效度，如功能下降和跌倒 一般应急者(目标2)；实施以可改变风险为目标的多成分干预试点 脆弱因素，如一般应答者子集中不适当的用药(目标3)。识别 脆弱性的可修改风险因素有可能影响整个WTCHP的老年WTC响应者。 这项研究的结果将有助于提高WTCHP监测和照顾老龄化的能力 通过与西奈山国家认可的老年医学和姑息治疗合作的应急者 方案，包括为世贸中心量身定做的未来广泛的多因素预防方案 响应人员促进健康老龄化。

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.