The Aging Process of WTC Responders: Assessment and Consequences of Frailty

项目总结/摘要 虽然WTC一般反应队列正在老龄化（平均年龄= 56），但WTC健康计划（WTCHP） 并没有定期收集与衰老相关的综合征的数据。特别是，虚弱是一种综合征，其特征在于 增加对不良事件的脆弱性，包括死亡率、发病率、残疾和住院。我们 初步数据表明，几乎三分之一的一般应答者WTC队列符合虚弱标准， 随着年龄的增长，WTC暴露，以及职业类型（例如， 建筑工人）。这些发现强调了对结构化的 与年龄相关的指标。因此，本研究的总体目标是评估以前是否 WTC暴露导致过早的与年龄相关的生理功能恶化。我们要建一个世贸中心- 基于定期检查的临床可观察到的衰老体征和症状的特定临床虚弱指数 在WTCHP监控范围内。我们将使用WTC一般应答者队列的存储库进行分析 自2009年以来，西奈山临床卓越中心（CCE）收集了健康监测数据， 2002.此外，我们将从WTC一般反应者队列中招募500名个体， 西奈山临床CCE收集认知功能，握力，体重减轻，身体 活动，疲惫和步行速度，这将提高WTC临床虚弱指数的准确性。 我们将首先使用新收集的以下指标为WTC特异性临床FI建立经验证的虚弱临界值： 认知、握力、步行速度、无意减肥、体力活动和疲劳（目标1）。 将评估WTC暴露严重程度对WTC应答者虚弱发展的影响（目标2） 以及WTC暴露（和其他潜在风险因素）与虚弱轨迹的关联（目标3）。中 目的探索性的，我们将评估虚弱对其他年龄相关综合征（功能下降和 福尔斯）和主要后果（住院）。识别可改变的过早衰老风险因素， 可能影响整个WTCHP，这是一个老龄化队列，具有更高的负面后果风险。 我们对衰老和脆弱的更广泛关注是WTCHP从暴露和创伤的范式转变- 相关伤害。这项研究的结果将有助于提高WTCHP监测和 通过与老年医学和姑息治疗计划合作，为老年反应者提供护理，包括 发展未来关于特定多因素预防方案有效性的干预研究。

Project Summary/Abstract Although the WTC general responders cohort is aging (average age=56), the WTC Health Program (WTCHP) does not routinely collect data on aging-related syndromes. In particular, frailty is a syndrome characterized by increased vulnerability to adverse events including mortality, morbidity, disability, and hospitalizations. Our preliminary data indicate that almost one-third of the General Responders WTC cohort meets criteria for frailty, an association that increases with age, WTC exposure, and by occupation type (e.g. higher risk among construction worker). These findings underscore the need for routine systematic assessments of structured age-related indicators in the cohort. Therefore the overarching aim of this study is to assess whether previous WTC exposure leads to premature age-related deterioration in physiological function. We will develop a WTC- specific clinical frailty index based on clinically observable signs and symptoms of aging regularly examined within WTCHP surveillance. We will carry out analyses using the repository of WTC general responders cohort health monitoring data that has been collected at the Mount Sinai Clinical Center of Excellence (CCE) since 2002. Additionally, we will recruit 500 individuals from the WTC general responders cohort who are followed at the Mount Sinai Clinical CCE to collect new measures of cognitive function, grip strength, weight loss, physical activity, exhaustion and walking speed, which will improve the accuracy of the WTC clinical frailty index. We will first establish a validated frailty cutoff for a WTC-specific Clinical-FI using newly collected measures of cognition, grip strength, walking speed, unintentional weight loss, physical activity, and exhaustion (Aim 1) .We will assess the influence of WTC exposure severity on the development of frailty in WTC responders (Aim 2) and the association of WTC exposure (and other potential risk factors) with frailty trajectories (Aim 3). In an exploratory Aim we will assess the influence of frailty on other age-related syndromes (functional decline and falls) and key consequences (hospitalizations). Identifying modifiable risk factors for premature aging has the potential to impact the entire WTCHP, which is an aging cohort and at higher risk for negative consequences. Our broader focus on aging and frailty serves as a paradigm shift in the WTCHP from exposure and trauma- related injury. Results of this study will be instrumental in improving the capacity of the WTCHP to monitor and care for aging responders through partnership with Geriatrics and Palliative Care programs, including the development of future intervention research on the effectiveness of specific multifactorial preventive programs.