My patient-oriented research (POR) program addresses knowledge gaps and barriers to care of hospitalized older adults with delirium. I seek renewal of my National Institute on Aging (NIA) K24 Award to continue to effectively leverage my ongoing research to mentor new investigators in aging research.
My Aims are:
Aim 1. To continue to conduct high quality POR research that will translate into improved care for hospitalized older adults with delirium, with an emerging focus on Implementation Science. This will be accomplished through my ongoing funded projects, and a newly funded R01 that moves toward implementation. Current Research: Much of my current research seeks a better understanding of delirium pathophysiology, with a goal of developing new biomarkers that could lead to improved diagnosis, monitoring, prognostication and the development of targeted therapies. My major project ?Biomarker Discovery for Delirium? within the P01 ?Interdisciplinary Study of Delirium and Its Long Term Outcomes? identified several new delirium biomarkers, including cytokines and acute phase reactants. With funding from the R01, ?Advancing Understanding of Postoperative Delirium Mechanisms via Multi-OMICS?, we are validating these protein biomarkers in larger samples, discovering new lipid and metabolite biomarkers, and examining cerebrospinal fluid. New Research: My new research seeks to implement efficient, straightforward tools for delirium identification in hospitalized elders. My recently completed R01, ?3D-CAM: Deriving and Validating a 3-minute Diagnostic Assessment for Delirium? developed and validated a high performing short diagnostic tool for delirium, the 3D- CAM, and identified ultra-brief screening tools. My newly funded R01: ?READI: Researching Efficient Approaches to Delirium Identification?, aims to test these tools in the hands of clinicians, and to assess barriers and facilitators to implementation. The long term of goal of this research is to implement routine assessment of delirium into care of hospitalized older adults, improving diagnosis, monitoring, and prognostication.
Aim 2 : To continue to use my research as a platform to mentor new POR investigators in delirium research, and to help them become independent investigators. This will support both the expansion of my research program and the field of delirium research.
This aim will be accomplished by: i. direct involvement of my trainees in my ongoing projects, ii. leveraging my programmatic research infrastructure to enable my mentees' investigations, and iii. ongoing recruitment of high caliber mentees to my research and mentoring program. Impact: Despite steady progress in delirium research over the past 25 years, much of the advances in this field have failed to reach the bedside of vulnerable hospitalized older adults. The focus of my ongoing projects and newly funded research, my proposed career development activities in Implementation Science, and my ongoing skilled mentorship of new investigators, will help to move the field of delirium research forward and will directly address the critical need to bring high quality care to the millions of older adults affected by delirium.
Delirium (acute confusion) complicates over 25% of the more than 12 million hospital stays per year of older adults in the U.S., leading to substantial morbidity, mortality, and cost. While there has been steady progress in delirium research, many advances have yet to impact the care of vulnerable hospitalized older adults. The ongoing and new research to be undertaken during the second cycle of this K24 Award, coupled with further expansion of Dr. Marcantonio's mentorship program to train outstanding young investigators, will address the critical need to bring high quality care to the bedside of the millions of older adults affected by delirium.
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