Over 2.5 million older Americans develop delirium (acute confusional state) each year, a common and serious geriatric syndrome, with associated mortality rates of 25-33% and accounting for >$100 billion in healthcare expenditures in the ensuing year. Yet, less than 30% of these cases are recognized, and even fewer receive proven preventive interventions. Clinical care to address and prevent delirium is deficient both because empirical evidence is lacking and because existing evidence is not consistently translated in an effective manner. The Candidate, Dr. Inouye, is an expert geriatrician and experienced clinical investigator, who has conducted ground-breaking work to advance our understanding of the diagnosis, risk factors, prognosis, and interventions for delirium. For this K07 Leadership Award, she proposes to develop the nation's first program focusing specifically on delirium in older adults, the "Center of Excellence for Delirium in Aging: Research, Training and Educational Enhancement (CEDARTREE)" to advance delirium research and training. She will establish this program at Harvard Medical School-Hebrew Rehabilitation Center, bringing together world-renowned resources in clinical-translational research, geriatrics/gerontology, and superb interdisciplinary expertise and resources to support the program, which will stimulate research across the greater Boston academic community.
The specific aims are to: 1) To create a comprehensive interdisciplinary training and mentorship program in delirium research, including a formal didactic curriculum, seminar series, collaborative working groups, and individualized mentorship with experienced investigators;2) To develop core resources to attract interdisciplinary investigators to engage in collaborative delirium-related research (e.g., website research development grants, access to novel research technologies and databases, investigator listserve, statistical/methodological expertise, and delirium bibliography);and 3) To serve as a local and national resource for research on delirium in aging through disseminating website resources and educational content, hosting a visiting scholar program, annual scientific symposium, interest groups at national meetings, and developing national linkages to translate evidence. Innovative approaches will be incorporated at every level of the program: translational research on delirium (biomarkers, genomics, advanced neuroimaging), advanced statistical methods to address methodological challenges, and innovative educational strategies (e.g., interactive on-line educational approaches). For Dr. Inouye, the K07 award will provide the opportunity for further career development in key leadership areas and protect time needed to develop, fully implement, evaluate, refine, and establish the self-sustaining infrastructure to assure continuation of the center as an enduring contribution to aging research and training. CEDARTREE represents the first resource of its kind, providing an innovative and much-needed local/national resource and focal point that will enhance the capacity for research on delirium in aging, with the ultimate goal of improving health and quality of life for seniors.

Public Health Relevance

Over 2.5 million older Americans develop delirium (acute confusional state) each year, leading to substantial morbidity, mortality, and cost. The overall goals of this K07 Leadership Award are to develop the nation's first center of excellence focusing specifically on research and training to address delirium in older persons, and to optimize clinical care for delirium through research and knowledge translation. Ultimately, this Center will expand research capacity and serve as a national resource and focal point to improve health and quality of life for older Americans.

National Institute of Health (NIH)
Academic/Teacher Award (ATA) (K07)
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Neuroscience of Aging Review Committee (NIA)
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Salive, Marcel
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Hebrew Rehabilitation Center for Aged
United States
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Inouye, Sharon K; Kosar, Cyrus M; Tommet, Douglas et al. (2014) The CAM-S: development and validation of a new scoring system for delirium severity in 2 cohorts. Ann Intern Med 160:526-33
Marcantonio, Edward R; Ngo, Long H; O'Connor, Margaret et al. (2014) 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med 161:554-61
Yue, Jirong; Tabloski, Patricia; Dowal, Sarah L et al. (2014) NICE to HELP: operationalizing National Institute for Health and Clinical Excellence guidelines to improve clinical practice. J Am Geriatr Soc 62:754-61
Inouye, Sharon K; Marcantonio, Edward R; Metzger, Eran D (2014) Doing Damage in Delirium: The Hazards of Antipsychotic Treatment in Elderly Persons. Lancet Psychiatry 1:312-315
Neufeld, Karin J; Nelliot, Archana; Inouye, Sharon K et al. (2014) Delirium diagnosis methodology used in research: a survey-based study. Am J Geriatr Psychiatry 22:1513-21