Frailty: Limits of Resilience and Interventions

Here we have three examples of faculty's work in the realm of resilience:  Linda P. Fried, MD; Matthew Baldwin, MD; and Guohua Li, DrPH, MD.

 

An example of the limits of resilience and plasticity, frailty is a clinical state in which there is an increase in an individual's vulnerability for developing increased dependency and/or mortality when exposed to a stressor.  Dean Linda Fried of the Mailman School of Public Health was a lead author of a 2001 paper in the Journal of Gerontology: Medical Sciences that was the first to define frailty as a clinical syndrome and propose criteria for identifying the condition. Dr. Fried has also led teams of scientists who have defined the biologic alterations underlying the development of frailty and the risks associated with the condition.

Central Reference:
1. Morley, J. E., Vellas, B., Abellan van Kan, G., Anker, S. D., Bauer, J. M., Bernabei, R., . . . Walston, J. (2013). Frailty Consensus: A Call to Action. Journal of the American Medical Directors Association, 14(6), 392-397. 

 

 

 

 

 

 

 

 

 

 

 

 

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Dr. Matthew Baldwin’s research is in critical care outcomes with a focus on examining frailty in older intensive care unit (ICU) survivors of respiratory failure. The overall hypothesis of his research is that outcomes of critical illness in older adults could be dramatically improved by understanding the determinants of those outcomes and patient treatment preferences, and then by designing interventions based on that understanding during the post-ICU care period (which includes post-ICU acute care, post-acute facility care, or home care after hospital discharge).

Improving Critical care Outcomes for Older Patients (I-CO-OP) Study
Dr. Baldwin has received a KL2 award from the Columbia CTSA, and a pilot study and 5-year K23 award from the NIA. The major focus of his research starting in July 2014 will be a 3-year prospective cohort study of older ICU survivors with the primary aim of developing frailty-based risk-stratification models that can then be used to identify older ICU survivors most appropriate for rehabilitative, therapeutic, and palliative interventions in the post-ICU care period.

Further research opportunities with this cohort study include:

  1. identifying phenotypes of neuromuscular weakness among older ICU survivors in order to determine the best candidates for rehabilitation,
  2. identifying biomarkers of frailty
  3. identifying social determinants of recovery after critical illness in older adults, and
  4. piloting rehabilitative interventions in older ICU survivors (e.g. inspiratory muscle training).

Please visit Dr. Baldwin's laboratory web-page here for more information.

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Dr. Guohua Li, Finster Professor and Director of the Center for Injury Epidemiology and Prevention, studies transportation safety and the needs of senior drivers and how self-regulation can lead to resilience.

His project, The LongROAD Study, funded by the AAA Foundation for Traffic Safety, is a longitudinal multi-site study designed to answer five questions about older drivers:

  1. What are the main protective and risk factors of safe driving in older drivers?
  2. What medications are most strongly associated with driving performance and behavior?
  3. How do drivers self-regulate their driving behaviors to cope with physical and cognitive declines?
  4. What is the role of new vehicle technology and post-market vehicle adaptations in driving safety?
  5. What are the determinants and impacts of driving cessation (eg. on the health and quality of life)?

The study spans five sites in California, Colorado, Maryland, Michigan and New York and began recruiting seniors 65-79 in 2015. Aging Center faculty member Dr. Thelma Mielenz is a co-principal investigator of the New York site. To read more about the study, visit the official website (http://www.longroadstudy.org/).