Lauren Ferrante, MD, MHS, received the 2021 American Geriatrics Society Outstanding Junior Investigator of the Year award for her work at the intersection of critical care medicine and geriatrics.
Ferrante, assistant professor of medicine at the Section of Pulmonary, Critical Care & Sleep medicine (Yale-PCCSM); and director, Operations Core, Yale Claude D. Pepper Older Americans Independence Center, has spent much of her career studying geriatric factors in intensive care. “Early on, one of the main contributions we made was to demonstrate that certain geriatric factors that we don't often think about in the intensive care unit (ICU), or at least hadn't until fairly recently, are important contributors to patient outcomes, especially functional outcomes,” said Ferrante. “We focus on function as an outcome because that's the health outcome that older adults value the most. Critical care medicine historically has focused on mortality, but as a field we are now focusing more on patient-centered outcomes, such as function.”
Another major contribution Ferrante and her team have made is demonstrating that pre-ICU functional trajectory, pre-existing frailty, and cognitive impairment are strong influencers of patient functional outcomes in older adults who have been discharged from the ICU. She is now applying that knowledge in the National Institute on Aging (NIA)-funded study to identify older adults who are at high risk of poor functional recovery post-ICU. “We've built a prediction model to identify high-risk patients as they're leaving the hospital and starting the course of their functional recovery, because functional recovery takes a few months, and you want to make sure you're intervening early,” said Ferrante. “The clinical team can apply this prediction model to patients being discharged—you just plug in a few numbers and it will tell you if someone is at high risk of not recovering. That will help the team to target care in terms of closer follow-up or discharging a patient to a post-ICU clinic.”
Ferrante’s program also includes an ongoing study of older COVID survivors. “We have a National Institute on Aging-funded COVID study, where we are evaluating longitudinal outcomes for older adults who have been hospitalized with COVID,” said Ferrante. “Early in the pandemic, my co-principal investigators (Andrew Cohen, MD, DPhil, and Alexandra Hajduk, PhD, MPH) and I noticed that everyone was focused on how older adults were at greater risk of hospitalization and death, but nobody was talking about the fact that the vast majority of them still survive. Nobody was studying their long-term outcomes, especially in these areas that matter the most to older adults—physical function, cognition, mental health, and symptom burden.”
Besides evaluating geriatric-specific long term COVID-19 outcomes, the VALIANT study may also help identify issues of healthcare access among older adults. As one of the physicians seeing patients at Yale-PCCSM’s post-COVID RECOVERY program, Ferrante has noticed that most of those patients are younger than 65. “I don't think that's because the older adults aren't having symptoms,” said Ferrante. "A quick look at our data suggests they're having a high burden of symptoms also. I suspect it has to do with the fact that older adults are more likely to have mobility limitations or transportation limitations that might affect their ability to come in for clinic appointments. That’s a reason that the VALIANT study will be important, because if we demonstrate that older adults have the same burden of symptoms and functional impairments that younger adults have, and the issue is getting them to a post-COVID program, then we can try a Telehealth model or a collaborative model with their primary physician.”
Ferrante has also moved into implementing interventions for geriatric patients in the ICU through the ACE-ICU study (Feasibility, Acceptability, and Barriers to Implementation of a Geriatrics Bundle in the ICU: a Pilot Study), which is funded by a Yale Pepper Center award and is still underway in the ICU. For this implementation science study, she considered components of successful geriatric models of care that already exist for hospitalized older adults but have yet to be applied to the ICU. “Some examples include the Acute Care for Elders (ACE) model, which is widely used on geriatrics units,” said Ferrante. “I intentionally used ACE in the ACE-ICU study name because it refers to a very successful geriatric model of care that's already implemented on many hospital floors. The study pulls elements that we've found to be important for the older ICU population and leverages what we already know about geriatric models of care.”
Ferrante says she is particularly grateful for this award, and the recognition she has received from the geriatrics community. “It has always been an important community to me in terms of the focus of my work and my ability to advocate for the integration of aging principles into the specialties, including critical care medicine,” said Ferrante. “My work involves bridging two specialties – and that requires the support of both sides of the bridge. This award is very meaningful, and I was delighted to find out I had been chosen as the recipient.”
The Section of Pulmonary, Critical Care and Sleep Medicine is one of the eleven sections within YSM’s Department of Internal Medicine. To learn more about Yale-PCCSM, visit PCCSM’s website, or follow them on Facebook and Twitter.