Promoting healthy aging and improving medication use in World Trade Center general responders

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. Because the WTC General Responder Cohort (WTC-GRC) is aging (median age is 61 in 2023), the WTC Health Program (WTCHP) needs to be prepared to deliver care that is best aligned to the needs of the aging WTC responder population. Frailty, a common geriatric syndrome characterized by increased vulnerability to adverse events including mortality, morbidity, disability and hospitalizations is prevalent among the WTC-GRC population and will likely continue to grow as the population ages. Our team has previously demonstrated that approximately 30% of the WTC- GRC 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 an urgent need for the targeting of potential vulnerabilities of this population as they age. This project will investigate two key questions central to developing aging-related interventions in the WTCHP. The first question is to understand how evidence-based healthy aging interventions can be best implemented in the WTCHP to meet the needs of WTC responders. This study will examine the implementation of a deprescribing intervention as an evidence-based practice to improve the use of medications in aging populations. Key information about implementation of this practice in the Mount Sinai WTCHP will be examined to identify barriers to implementation and identify strategies, processes and tools to support its implementation. Perspectives from key stakeholders at a novel site for the evidence-based practice will be collected in order to prepare for further dissemination of this deprescribing intervention. The second question is to understand health priorities of the WTC-GRC as they age. Examination of these health priorities will allow for further planning of healthy aging initiatives, as well as selection and prioritization of additional evidence-based practices needed in future efforts to support WTC responders. Results of this project will be instrumental in improving the capacity of WTCHP to care for aging responders through partnership with Mount Sinai's nationally recognized Geriatrics and Palliative Care programs including the development of future widespread multifactorial programs tailored to WTC responders to promote healthy aging.