Research to Improve ICU Outcomes Among Older Adults
The mission of the Research to Improve ICU Outcomes Among Older Adults (RECOVER) Program is to improve the care and outcomes of older adults in the intensive care unit (ICU). The program is led by Lauren Ferrante, MD, MHS, a pulmonary and critical care physician with expertise in aging research, who also serves as a core director in the Yale Claude D. Pepper Older Americans Independence Center. Work conducted in the program bridges critical care medicine and geriatrics to improve our understanding of patient-centered outcomes and develop interventions for older adults in the ICU or who have survived critical illness. Through epidemiologic analysis of large datasets, enrollment of new observational patient cohorts, and interventional studies, research conducted in the program aims to improve the outcomes of older adults across the spectrum of critical illness and recovery.
About Our Work
Adults aged 65 and older make up more than half of all ICU bed-days, a trend that is expected to continue with the aging of the U.S. population. To provide personalized care in the ICU, it is important to consider the unique factors that may impact older adults, such as pre-existing frailty, hearing loss, or cognitive impairment. Moreover, research has shown that older adults most value health outcomes such as maintaining functional independence and quality of life. The goal of the RECOVER program is to unite these personalized considerations and health priorities through science to achieve the outcomes that matter most to older adults in the ICU.
Research
Nearly two million older adults are admitted to an ICU every year; of those who survive, half will not achieve functional recovery. LANTERN is a prospective (observational) cohort study that enrolls older adults who have survived an ICU stay, ascertains their unmet needs after discharge, and evaluates how these unmet needs affect outcomes such as functional disability and rehospitalizations. The results from LANTERN will inform the development and evaluation of interventions to improve functional outcomes among older ICU survivors.
Geriatric Models of Care in the ICU (ACE-ICU)
Geriatric models of care, such as Acute Care for Elders (ACE) units, have been shown to improve outcomes in hospitalized older adults outside the ICU. We identified components from these models that are not routinely implemented in ICUs and developed a geriatrics bundle comprising three interventions: treatment of hearing impairment, deprescribing of potentially inappropriate medications (PIMs), and default provision of occupational therapy (OT). In a pilot clinical trial, this bundled intervention reduced incident delirium in older adults.
Secondary Data Analysis of Nationally Representative Cohorts Linked to Administrative Data
Our team has extensive experience using nationally representative cohort studies, such as the National Health and Aging Trends Study (NHATS), linked to Medicare data to conduct longitudinal analyses evaluating health outcomes among older ICU survivors. In these projects, we are particularly interested in the outcomes of vulnerable older adults, such as those with age-related vulnerability (frailty, cognitive impairment), social vulnerability (social isolation), and socioeconomic disadvantage or health-related social needs.
Secondary Data Analysis Study Team
Leadership
Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine); Director, Operations Core, Yale Claude D. Pepper Older Americans Independence Center; Student Thesis Chair, Internal Medicine
Dr. Ferrante is an Associate Professor in Pulmonary & Critical Care Medicine at the Yale School of Medicine and a Core Director at the Yale Claude D. Pepper Older Americans Independence Center. Her research program, funded by the National Institute on Aging (NIH/NIA), is centered at the interface of critical care medicine and geriatrics, with the overarching goal of understanding and improving the functional outcomes of critically ill older adults. Dr. Ferrante’s work has been recognized most recently with the Jo Rae Wright Award for Outstanding Science (2023) from the American Thoracic Society (ATS), where she also served as Chair of the Critical Care Program Committee for the ATS 2024 International Conference. Clinically, Dr. Ferrante is an attending physician in the Medical Intensive Care Unit at Yale-New Haven Hospital and in the Winchester Center for Lung Disease. Active projects: 1. Evaluating the Unmet Needs of Older Adults to Promote Functional Recovery after a Critical Illness (LANTERN). National Institute on Aging, R01 AG079916; role: PI 2. COVID-19 in Older Adults: A Longitudinal Assessment (VALIANT). P30 AG021342-18S1; role: mPI 3. Secondary analysis of data in the National Health and Aging Trends Study (NHATS): Health Outcomes Among Older Adults with Medical and Social Vulnerability 4. Otoacoustic Emissions Testing to Identify Hearing Loss in the ICU: a Feasibility Study. OAIC Flexible High Value Award, U24 AG059624; role: mPI. Completed Grant Funding (selected): Paul B. Beeson Emerging Leaders Career Development Award in Aging: The PREDICT Study (PRE-ICU Determinants of Post-ICU FunCTional Outcomes among Older Adults). National Institute on Aging, K76 AG057023; role: PIFeasibility, Acceptability, and Barriers to Implementation of a Geriatrics Bundle in the ICU: a Pilot Study (ACE-ICU). Pepper Pilot Award, Yale Pepper Center; role: PIGEMSSTAR (Grants for Early Medical/Surgical Subspecialists' Transition to Aging Research) awardee Pepper Scholar Career Development Award T. Franklin Williams Scholar (ATS/AAIM-ASP Career Development Award in Geriatrics) Parker B. Francis Research Opportunity Award (converted from a Parker B. Francis Fellowship Award after concurrent receipt of K) Awards (selected): Jo Rae Wright Award, American Thoracic Society, 2023 Critical Care Early Career Achievement Award, American Thoracic Society, 2022 Outstanding Junior Investigator of the Year Award, American Geriatrics Society (AGS), 2021 Inaugural Arti Hurria Memorial Award for Emerging Investigators in Internal Medicine, American Geriatrics Society (AGS), 2019 Intensive Care Global Rising Star Award, Australia and New Zealand Intensive Care Society (ANZICS), 2018 AGS/Merck New Investigator Award, 2016 Iva Dostanic Physician-Scientist Award, Yale School of Medicine, 2016 Training: Internal Medicine residency: Columbia University Medical Center, New York, NY Pulmonary and Critical Care Medicine Fellowship: Yale School of Medicine, 2015 Fellowship in Geriatric Epidemiology and Aging-Related Research (T32): Yale School of Medicine, 2015 Master of Health Science (MHS) degree: Yale School of Medicine, 2016