Despite hospitals’ best efforts, there is no evidence that policies to inhibit patient mobility actually prevent falls and may actually increase the risk of serious side effects, according to Sharon K. Inouye, MD, MPH, Director of the Aging Brain Center at the Institute for Aging Research, Hebrew SeniorLife.
“According to a 2009 estimate, hospital patients spend over 95% of their time in bed. In –hospital immobility is one of several factors theorized to give rise to the “posthospital syndrome,” a transient state of heightened vulnerability following hospitalization that is associated with an increased risk of functional decline, medical adverse events, and hospital readmission,” writes Inouye in the April 24 issue of JAMA Internal Medicine.
From 10/1/16-9/30/17, Dr. Sharon Inouye will participate in the Health and Aging Policy Fellowship. One of sixteen fellows selected from a national pool of leaders in aging research, Dr. Inouye will be placed within a Washington DC or state agency and work closely with goverment organizations to complete a health policy project aimed at improving the lives of older adults.
In September of 2016, a team of 12 delirium experts led by Sharon K. Inouye, MD, MPH, Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center at the Institute for Aging Research (IFAR) at Hebrew SeniorLife, was awarded a projected $3.7 million grant by the National Institute on Aging to create an interdisciplinary Network for Investigation of Delirium across the U.S. (NIDUS).
This network to unite delirium researchers from 27 organization across the US and accelerate collaboration and scientific discovery in delirium research is the first of its kind funded by the NIA. "We are delighted to support the launch of this team effort to build a research infrastructure advancing our understanding of how delirium impacts the aging brain," said NIA program officer Molly Wagster, Ph.D. "This highly collaborative and innovative effort promises to inform delirium research and clinical care for years to come."
Delirium is a common clinical syndrome in older adults, which presents as an acute mental condition characterized by confused thinking and disrupted attention. Affecting over 2.6 million older adults in the U.S. each year, typically following surgery, hospitalization or acute illness, delirium can be serious and life-threatening, often leading to loss of independence, cognitive decline, an increased risk of morbidity and mortality, and costing more than $164 billion per year in healthcare expenditures. Despite its importance for the health and wellbeing of older adults, delirium is not well understood and is vastly under-recognized. However, "by bringing together multiple experts across disciplines--with varying approaches and skill sets-- I truly believe we will accelerate advancements in delirium,” says Inouye.
NIDUS, hoping to realize these advancements, will headed by Eva Schmitt, PhD of Hebrew SeniorLife as the overall Program Director. Dr. Schmitt will be assisted by Program Coordinator Kristen Erickson.
NIDUS will comprise two resource cores. The Research Resources and Database Core, led by Edward Marcantonio, MD, SM, of Harvard Medical School, and Pratik Pandharipande, MD, MSc, of Vanderbilt University Medical Center, will develop a database of ongoing delirium studies. “In creating such a database”, says Dr. Marcantonio “we will encourage multi-site collaboration, secondary analyses of existing delirium data, and facilitation of pilot studies, to catalyze advances in the field”.
A second resource core, the Measurement and Harmonization Core, will develop resources to help researchers choose and compare tools for assessing delirium. This core is led by Richard Jones, ScD, of the Warren Alpert Medical School of Brown University, and Dale Needham, MD, PhD, of Johns Hopkins University School of Medicine, and will ultimately assist in integrating information collected across multiple delirium studies. Thomas Travison, PhD, of Harvard Medical School and Hebrew SeniorLife, will provide support in development of databases to support these cores.
Three tasks forces will be established in NIDUS. First, to encourage innovative research into new areas of study, the Pilots and Innovation Task Force will provide pilot grants each year. This task force is led by the joint efforts of Thomas Robinson, MD, of the University of Colorado School of Medicine and Michael Avidan, MBBCh, of Washington University School of Medicine.
The second Task Force, the Mentorship and Career Development Task Force, co-led by Donna Fick, PhD, MSN, of the Pennsylvania State University, and E. Wesley Ely, MD, MPH, of Vanderbilt University Medical Center, will create an intensive training bootcamp for researchers new to the field of delirium, as well as provide ongoing opportunities for mentorship and career development. “This initiative will encourage new researchers to join this exciting and important field,” says Fick.
Andrew Auerbach, MD, of the University of California San Francisco, and Jan Busby-Whitehead, MD, of the University of North Carolina School of Medicine, will lead the Dissemination Task Force, which will hold an annual scientific symposium for delirium researchers and use social media and other approaches to communicate information about delirium research broadly. Dr. Auerbach notes that this task force “will help ensure that scientific efforts are disseminated with existing organizations, such as the American Delirium Society and European Delirium Association”.
NIDUS will also draw on the expertise of the 16-member external Scientific Advisory Board, chaired by Malaz Boustani, MD, Professor of Medicine at Indiana University School of Medicine, and former President of the American Delirium Society. The Advisory Board will provide feedback on program activities twice a year. Its members include members of the European Delirium Association, as well as experts in a variety of relevant areas including geriatric medicine, nursing, anesthesiology, emergency and ICU medicine, psychiatry, neurology, neuropsychology, palliative care, epidemiology, and patient advocacy.
In 2011, Sharon K. Inouye, MD, MPH, Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center at the Institute for Aging Research (IFAR) at Hebrew SeniorLife, was elected to the Institute of Medicine of the National Academies and was part of the team that wrote an important report on cognitive aging report, Cognitive Aging: Progress in Understanding and Opportunities for Action, addressing the concept of cognitive aging, its impact on public health, and the actions the nation needs to take to better understand and maintain the cognitive health of older adults. The report offers a variety of recommendations on how older adults can best promote cognitive health, highlighting the areas of exercise, diet, delirium prevention, and prudent use of medications. The report includes important policy recommendations which will impact broadly on public health.
You can view it at: http://www.iom.edu/Reports/2015/Cognitive-Aging.aspx
From 2012-2015, Dr. Inouye served as Co-Chair of the Guidelines Development Committee for Postoperative Delirium, American Geriatrics Society. The purpose of this clinical guideline is to improve clinical care of older adults through prevention and treatment of delirium in the postoperative setting. The guideline addressed the nonpharmacologic and pharmacologic interventions that should be implemented for the prevention and treatment of postoperative delirium.