A Longitudinal Study of Physical Activity and Function in Older Veterans with Serious Mental Illness

患有严重精神疾病的老年退伍军人身体活动和功能的纵向研究

• 批准号: 10536760
• 负责人: Julia Browne
• 金额: --
• 依托单位: PROVIDENCE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10536760
• 关键词: Address; Admission activity; Adult; Affect; Age; Aging; Award; Behavior Therapy; Bipolar Disorder; Characteristics; Chronic; Clinical; Data; Data Reporting; Dedications; Development; Diagnostic; Dimensions; Educational Status; Elderly; Electronic Health Record; Enrollment; Equilibrium; Ethnic Origin; Evaluation; Exercise; Gender; Geriatrics; Goals; Health; Health Promotion; Health Status; Health behavior; Intervention; K-Series Research Career Programs; Knowledge; Life; Long-Term Care; Longitudinal Studies; Major Depressive Disorder; Measures; Medical; Mental Health; Mentorship; Modality; Morbidity - disease rate; Nursing Homes; Patient Self-Report; Performance; Physical Exercise; Physical Function; Physical activity; Population; Population Programs; Process; Psychosocial Factor; Publishing; Quality of life; Race; Research; Risk; Schizoaffective Disorders; Schizophrenia; Site; Social support; Subgroup; Symptoms; Techniques; Time; Training; United States; Veterans; Work; advanced analytics; career; clinical database; clinical practice; comorbidity; disability; exercise program; experience; fall risk; falls; functional improvement; health related quality of life; improved; middle age; military veteran; mortality; multiple chronic conditions; neglect; peer; population based; programs; retention rate; sedentary; severe mental illness; skills

Serious mental illness (SMI), which includes the mental health conditions of schizophrenia, schizoaffective disorder, bipolar disorder, and major depressive disorder, disproportionately affects the Veteran population and is a leading cause of disability in the United States. Not only do Veterans with SMI experience mental health symptoms but they also have high rates of chronic medical conditions that further reduce quality of life. The physical burden of SMI compounds with age such that older Veterans with SMI have an even higher number of chronic health conditions, are at increased risk for falls, are more likely to be admitted to a nursing home and engage in physical activity less often than their same age peers without SMI. As a result, the multimorbidity faced by older Veterans with SMI significantly reduces the independence and functioning of this population. Multicomponent exercise is an established modality to improve the health of older Veterans and is particularly effective for increasing all facets of physical function (cardio/endurance, strength, mobility, balance). Physical function, which is known to worsen during the aging process, particularly with increased sedentary time, is a critical intervention target for older Veterans given its association with independence, quality of life, falls, and survival. Despite the compromised health of older Veterans with SMI and the established benefits of exercise for older Veterans, there is a lack of research on physical function and exercise for this population. This Career Development Award (CDA-1) will fill this gap by exploring function and physical activity in older Veterans with SMI who participated in Gerofit, a national VA-supported clinical exercise program. The Gerofit clinical database contains performance-based physical function data on balance, mobility, lower/upper body strength, and endurance/cardio as well as self-report data on health-related quality of life and social support collected at enrollment, three months, six months, and 12 months. These data have been collected from 1,698 older Veterans from 11 (out of 17) national VA sites from 2007-2019, of which 14% (n=236) have SMI. The Gerofit clinical database and SMI diagnostic information obtained from the VA electronic health record will be used to examine three aims: (1) characterize the baseline function of older Veterans with SMI in Gerofit across all functional domains (balance, mobility, strength, endurance/cardio) by comparing them to age- and gender-based population norms and to older Veterans without SMI in Gerofit, (2) evaluate one-year changes in all domains of physical function of older Veterans with SMI in Gerofit and compare the magnitude of change to that of older Veterans without SMI in Gerofit, and (3) examine six- and 12-month Gerofit program retention in older Veterans with SMI by comparing retention rates by SMI status (SMI vs. non-SMI) and examining baseline predictors of retention in older Veterans with SMI including age, race, ethnicity, health-related quality of life, social support, and physical function. Dr. Browne’s training plan will facilitate completion of these aims and the development of new skills (e.g., assessment and interpretation of function, advanced analytic techniques) and content knowledge (e.g., intersection of aging and mental health, health promotion of older Veterans with SMI). She will participate in didactic and professional development activities throughout the award period to support achievement of these training goals and receive mentorship from a team of experts in aging, SMI, exercise, physical function, and Veteran health (Drs. Katherine Hall, Miriam Morey, Eric Elbogen, Kim Mueser). This CDA-1 will also generate necessary pilot data for a subsequent CDA-2 application, which will be a natural extension of this work. This CDA-1 award is an essential first step to advance Dr. Browne’s long-term career goals of developing behavioral interventions to improve the quality of life and reduce the burden of multimorbidity in older Veterans with SMI and integrating health promotion into routine clinical practice.

严重精神疾病(SMI)，包括精神分裂症、分裂性情感障碍患者的心理健康状况 精神障碍、双相情感障碍和严重抑郁障碍，对退伍军人和 在美国是导致残疾的主要原因。不仅患有SMI的退伍军人体验到心理健康 但他们也有很高的慢性病患病率，进一步降低了生活质量。这个 SMI的身体负担随着年龄的增长而增加，因此患有SMI的老年退伍军人有更多的 慢性健康状况，跌倒的风险增加，更有可能住进疗养院，并 与没有SMI的同龄同龄人相比，他们参加体育活动的频率更低。因此，多发病面临着 患有重度精神障碍的老年退伍军人极大地降低了这一群体的独立性和功能。 多成分运动是一种改善老年退伍军人健康的既定方式，尤其是 有效提高身体机能的各个方面(有氧/耐力、力量、机动性、平衡性)。物理 功能，已知在衰老过程中恶化，特别是随着久坐时间的增加，是一种 老年退伍军人的关键干预目标，因为它与独立性、生活质量、跌倒和 生死存亡。尽管患有SMI的老年退伍军人的健康受到损害，而且锻炼对 对于年龄较大的退伍军人来说，缺乏对这一群体的身体机能和锻炼的研究。这份职业 发展奖(CDA-1)将通过探索老年退伍军人的功能和体力活动来填补这一空白 SMI参加了Gerofit，这是一个由退伍军人管理局支持的国家临床锻炼计划。Gerofit临床数据库 包含基于性能的身体机能数据，包括平衡、活动能力、下半身/上半身力量，以及 耐力/有氧运动以及与健康相关的生活质量和社会支持的自我报告数据，收集地址为 注册，三个月，六个月，和12个月。这些数据是从1698名老年退伍军人中收集的 从2007-2019年的11个(17个)国家退伍军人事务部站点，其中14%(n=236)具有SMI。Gerofit临床 从退伍军人管理局电子健康记录中获得的数据库和SMI诊断信息将用于检查 三个目标：(1)用Gerofit中的SMI对所有职能部门的老年退伍军人进行基线功能表征 领域(平衡、活动能力、力量、耐力/有氧运动)与基于年龄和性别的比较 人口常模和Gerofit中没有SMI的老年退伍军人，(2)评估所有领域的一年变化 Gerofit中患有SMI的老年退伍军人的身体功能，并比较其变化幅度 在Gerofit中没有SMI的退伍军人，以及(3)检查老年退伍军人6个月和12个月的Gerofit计划保留率 通过按SMI状态(SMI与非SMI)比较保留率，并检查 老年退伍军人对SMI的保留包括年龄、种族、民族、与健康相关的生活质量、社会支持、 和身体机能。布朗博士的培训计划将促进这些目标的实现和发展 新技能(例如，评估和解释功能、高级分析技术)和内容知识 (例如，老龄化和心理健康的交叉，使用SMI促进老年退伍军人的健康)。她将参加 在整个授奖期间的教学和专业发展活动中，支持实现这些目标 培训目标，并接受老龄化、SMI、运动、身体机能和 资深健康专家(Katherine Hall博士、Miriam Morey博士、Eric Elbogen博士、Kim Mueser博士)。这个CDA-1也将生成 为随后的CDA-2应用提供必要的试点数据，这将是这项工作的自然延伸。这 CDA-1奖是推进布朗博士发展行为能力长期职业目标的重要第一步 改善老年退伍军人SMI患者生活质量和减轻多发病负担的干预措施 将健康促进纳入常规临床实践。