In the more than 20 years since the World Trade Center attacks on September 11, 2001, many studies have documented the high levels of disease among general responders from cancer, as well as respiratory and mental health disorders. Very little attention has been paid, though, to how these rescue and recovery workers are aging, and if their heroic actions at Ground Zero have rendered them more vulnerable to natural consequences of aging.
Investigators at the Brookdale Department of Geriatrics and Palliative Medicine have been working intensely to bridge that knowledge gap, knowing full well that the toxicants and psychological trauma that many responders were exposed to can significantly alter their aging process.
Drawing on copious data from the World Trade Center Health Program at Mount Sinai, they are conducting a host of studies with the help of grants from the Centers for Disease Control and Prevention that have suggested the general responder population is indeed more likely to experience premature aging, as evidenced most notably by frailty and its associated health declines.
“There’s a pressing need to characterize, assess, and monitor the development of age-related syndromes among this cohort since their WTC exposures can change the trajectory of their aging,” says Fred Ko, MD, MSCR, Associate Professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and Associate Director of the Geriatrics Research Education and Clinical Center at the James J. Peters VA Medical Center, and an investigator on the WTC series of studies. “We’ve found from our work that frailty is highly prevalent in the general responder population and can occur at an earlier age, which can seriously impact the quality of life for these individuals as well as mortality and morbidity.”
One way the Mount Sinai team has worked successfully to characterize aging among general responders is through the development and validation of a clinical frailty index (known as WTC FI-Clinical) to assess the burden of age-related clinical deficits, as well as to identify factors associated with frailty. As described in a 2021 study published in the Journal of Aging and Health, the index is based on a study of 6,197 responders with a median age of 51, and from data spanning multiple domains, including clinical conditions, health symptoms, and ability to perform activities of daily living. While the clinical frailty index shows a strong correlation with age, it is also influenced by 9/11 exposure severity, sex, race, pre-9/11 occupation, education, and smoking status of the first responder. The study focuses on general responders, who were rescue and recovery workers, and includes some first responders. There is a separate cohort of firefighters who are not currently involved in the study.
“The index will serve as an important tool to help clinicians who care for this population to assess, monitor, and track frailty,” says Dr. Ko, who is also an Associate Professor of Medicine (Hospital Medicine). “It can also be used to test through other studies the feasibility of a number of healthy aging interventions, such as exercise, nutritional supplementation, cognitive training, behavioral therapy, and reduction in the number of prescribed medicines that could be delivered through comprehensive geriatric care and management.”
Those potential interventions are precisely the subject of a frailty prevention study Dr. Ko hopes to soon pilot along with other co-investigators William Hung, MD, MPH, Professor in the Brookdale Department; Michael Crane, MD, MPH, Professor in the Department of Environmental Medicine and Public Health; and Katherine Ornstein, PhD, MPH, Professor in Johns Hopkins School of Nursing. A companion study proposes to look into medication deprescribing as a low-cost form of intervention. “Many general responders are on five or more medications, some of which can interact and have adverse outcomes,” says Dr. Ko. “The goal of this research is to remove from their daily regimen medicines that are more harmful than helpful, or replace them with alternatives that result in fewer issues.”
As important in managing the health trajectory of aging responders is the need for early intervention. “The frailty index we developed could be deployed in the clinic for not only routine frailty monitoring, but to identify individuals at risk for further decline based on accumulated deficits and physiological change,” says Dr. Ko. “The improvement in long-term health of aging general responders from such a proactive approach could be considerable.”