Exploring strategies to restore function in older Veterans with PTSD.

描述(由申请人提供) 探讨老年退伍军人创伤后应激障碍患者的功能恢复策略。这是一份CDA-1的申请书。该奖项的候选人是达勒姆退伍军人事务医疗中心老年研究、教育和临床中心博士后凯瑟琳·S·霍尔博士。米里亚姆·C·莫雷博士将担任主要导师，让·C·贝克汉姆博士和海登·B·博斯沃思博士将担任本次奖项的共同导师。这项提案的首要目标是，候选人建立一个研究项目，研究多种疾病对老年人行为和功能结果的影响；特别关注创伤后应激障碍(PTSD)以及老年人常见的慢性病带来的额外负担。霍尔博士将探索创伤后应激障碍对坚持治疗的额外负担，以及体力活动、行为和功能结果变化的纵向轨迹。霍尔博士在一项正在进行的临床试验(增强健身研究，Morey Pi)中确定了感兴趣的变量，并进行了初步分析，以探索PTSD对糖耐量受损的超重老年退伍军人的体力活动和功能的影响。霍尔博士提出的指导性研究试图通过检查基线关联和创伤后应激障碍对临床结果随时间的变化的影响，在这个数据集中广泛地表征这些关联。该奖项下的活动包括确定这一群体特有的体力活动障碍，并制定认知-行为战略，以解决患有多种疾病和创伤后应激障碍的老年人的具体障碍。这些目标的结果将为一项随机、受控运动干预的试点研究的未来发展提供信息，该研究旨在比较在这一未被研究但正在增长的老年退伍军人亚群中，基于群体的认知-行为干预与传统行为干预相比，提高对体育活动的依从性的有效性。霍尔博士的培训计划包括扩大和加强她对创伤后应激障碍的病因和表现的理解，探索创伤后应激障碍影响体育活动参与的潜在机制，加强她在认知行为技术方面的背景，并将这些原则应用于体育活动行为，以及对纵向和组间分析进行统计处理。考虑到应聘者在体力活动方面的强大背景，以及她在行为干预和功能评估方面的研究项目的经验，对创伤后应激障碍作为一种精神疾病的深入了解，以及进一步发展她的认知-行为和统计学知识基础，将提高她未来在这个竞争领域的生产力和潜力。我们的目标是，霍尔博士将开发一个新颖而独特的研究领域，该领域具有巨大的潜力，可以制定康复策略，以维持和恢复患有多种疾病的人群的功能，这些疾病正在老龄化，可能会给VAMC的医疗服务带来高功能负担。

DESCRIPTION (provided by applicant) Exploring strategies to restore function in older Veterans with PTSD. This is a submission for a CDA-1. The candidate for this award is Katherine S. Hall, Ph.D., a postdoctoral fellow at the Geriatric Research, Education, and Clinical Center of the Durham Veterans Affairs Medical Center. Dr. Miriam C. Morey will serve as a primary mentor and Drs. Jean C. Beckham and Hayden B. Bosworth will serve as co-mentors during this award. The overarching goal of this proposal is for the candidate to build a research program in the role of multiple morbidities on behavioral and functional outcomes in older adults; specifically focusing on the added burden of posttraumatic stress disorder (PTSD) in addition to chronic conditions common to older adults. Dr. Hall will explore the added burden of PTSD on adherence and longitudinal trajectories of change in physical activity behavior and functional outcomes. Dr. Hall has identified the variables of interest in an ongoing clinical trial (the Enhancing Fitness Study, Morey PI) and has performed preliminary analysis to explore the impact of PTSD on physical activity and function in a convenience sample of overweight, older Veterans, with impaired glucose tolerance. Dr. Hall's proposed mentored research seeks to extensively characterize these associations in this dataset by examining baseline associations and the effects of PTSD on changes in clinical outcomes over time. Activities under this award include identifying the barriers to physical activity unique to this population and develop cognitive-behavioral strategies to address specific barriers for older adults with multiple morbidities and PTSD. Results from these aims will inform the future development of a pilot study of a randomized, controlled exercise intervention designed to compare the effectiveness of a group-based cognitive-behavioral intervention for increasing adherence to physical activity compared to traditional behavioral interventions in this understudied, but growing, sub-population of older Veterans. Dr. Hall's training plan includes broadening and strengthening her understanding of the etiology and manifestations of PTSD, exploring the potential mechanisms by which PTSD influences physical activity participation, strengthening her background in cognitive-behavioral techniques and applying these principles to physical activity behavior, and statistical handling of longitudinal and between-group analyses. Given the candidate's strong background in physical activity and her experience with research projects in behavioral interventions and functional assessment, a strong knowledge of PTSD as a psychiatric comorbidity and further development of her cognitive-behavioral and statistical knowledge base will enhance her future productivity and potential in this competitive field. The goal is that Dr. Hall will develop a novel and unique area of research that has tremendous potential for developing rehabilitation strategies for maintaining and restoring function in a cohort with multiple morbidities that is aging and likely to impose a high functional burden on VAMC health services.