The National Institute of Aging K23 award will allow Dr. Han to develop as an independent investigator in the field of geriatric emergency medicine, and help him establish a research career devoted to the improvement of emergency care in the aging population. He will focus on delirium since it affects 10% of elderly emergency department (ED) patients, especially because this form of organ dysfunction is a major threat to the older patient's quality of life. The candidate's preliminary studies suggest that delirium is missed in 76% of the cases by emergency physicians and is a serious quality of care issue. However, there are significant barriers to improving delirium detection in the ED. First, there are no valid delirium assessments that are feasible to perform in the busy and demanding ED environment. Second, the clinical significance of delirium in the ED remains unknown and must be established in order for the emergency medicine community to accept routine surveillance as a part of standard ED practice. To overcome these obstacles, Dr. Han proposes a series of studies that will 1) develop a novel delirium surveillance for the ED which maximizes efficiency and minimizes ED staff burden, and 2) study how often ED delirium persists into hospitalization and determine how its duration affects 6-month mortality and functional decline. The ED is the gateway of the health care system and cares for over 15 million elderly patients per year. Yet emergency physicians are poorly equipped to take care of this rapidly growing population. Thus, focusing research efforts on the ED is vital to improving the quality of care delivered to the older patient. Such investigations are hampered by the severe shortage of federally funded ED investigators committed to aging research. Dr. Han will participate in a career development training program specifically tailored for his needs. He will take coursework in advanced epidemiology and biostatistics, and neuroscience. He will also spend time with the geriatrics and psychiatric inpatient consult service to learn how to assess the mental status of acutely ill elders. Dr. Han's training will be overseen by a multidisciplinary group of highly skilled and qualified mentors. By leveraging this plan with institutional strengths, he is poised to alter the way emergency physicians detect and treat elderly patients with delirium. Dr. Han's future goal is to develop ED-based delirium interventions based upon the data accrued from this proposal. These interventions will emphasize early diagnosis and treatment of delirium in the ED, and will potentially have a profound impact in the way ED cares for older adults.

Public Health Relevance

Delirium is a form of organ dysfunction that is characterized by an acute change in mental status, inattention, and either disorganized thinking or an altered level of consciousness. Although delirium is associated with a wide range of negative patient outcomes, physicians miss delirium at an alarmingly high rate. The candidate will therefore develop a delirium surveillance system specifically tailored for the challenging ED environment and establish its clinical significance so that routine ED screening of delirium can be justified.

Agency
National Institute of Health (NIH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23AG032355-05
Application #
8686692
Study Section
Neuroscience of Aging Review Committee (NIA)
Program Officer
Wagster, Molly V
Project Start
Project End
Budget Start
Budget End
Support Year
5
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Vanderbilt University Medical Center
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
City
Nashville
State
TN
Country
United States
Zip Code
37212
Gaspardo, Pietro; Peressoni, Luca; Comisso, Irene et al. (2014) Delirium among critically ill adults: evaluation of the psychometric properties of the Italian 'Confusion Assessment Method for the Intensive Care Unit'. Intensive Crit Care Nurs 30:283-91
Morandi, Alessandro; Hughes, Christopher G; Thompson, Jennifer L et al. (2014) Statins and delirium during critical illness: a multicenter, prospective cohort study. Crit Care Med 42:1899-909
Han, Jin H; Wilson, Amanda; Graves, Amy J et al. (2014) Validation of the Confusion Assessment Method for the Intensive Care Unit in older emergency department patients. Acad Emerg Med 21:180-7
Han, Jin H; Schnelle, John F; Ely, E Wesley (2014) The relationship between a chief complaint of "altered mental status" and delirium in older emergency department patients. Acad Emerg Med 21:937-40
Storrow, Alan B; Jenkins, Cathy A; Self, Wesley H et al. (2014) The burden of acute heart failure on U.S. emergency departments. JACC Heart Fail 2:269-77
Brummel, Nathan E; Vasilevskis, Eduard E; Han, Jin Ho et al. (2013) Implementing delirium screening in the ICU: secrets to success. Crit Care Med 41:2196-208
Han, Jin H; Wilson, Amanda; Vasilevskis, Eduard E et al. (2013) Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med 62:457-65
Han, Jin H; Wilber, Scott T (2013) Altered mental status in older patients in the emergency department. Clin Geriatr Med 29:101-36