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: 10782994
• 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/10782994
• 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.

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.

项目成果

Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure.

严重的精神疾病与患有心力衰竭的退伍军人再次入院的风险升高相关。

• DOI: 10.1016/j.jpsychores.2024.111604
• 发表时间: 2024
• 期刊: Journal of psychosomatic research
• 影响因子: 4.7
• 作者: Browne,Julia;Rudolph,JamesL;Jiang,Lan;Bayer,ThomasA;Kunicki,ZacharyJ;DeVito,AlyssaN;Bozzay,MelanieL;McGeary,JohnE;Kelso,CatherineM;Wu,Wen-Chih
• 通讯作者: Wu,Wen-Chih

COVID-19 mortality among veterans with serious mental illness in the veterans health administration.

• DOI: 10.1016/j.jpsychires.2023.05.024
• 发表时间: 2023-07
• 期刊: JOURNAL OF PSYCHIATRIC RESEARCH
• 影响因子: 4.8
• 作者: Bowersox, Nicholas W.;Browne, Julia;Grau, Peter P.;Merrill, Stephanie L.;Haderlein, Taona P.;Llorente, Maria D.;Washington, Donna L.
• 通讯作者: Washington, Donna L.