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.

严重的精神疾病（SMI），包括精神分裂症的心理健康状况 疾病，躁郁症和重度抑郁症，对退伍军人人口的影响不成比例 是美国残疾的主要原因。拥有SMI的退伍军人不仅会经历心理健康 症状，但它们的慢性病率也很高，可以进一步降低生活质量。 SMI化合物的物理伯恩（Burnen）随着年龄的增长 慢性健康状况，跌倒风险增加，更有可能被接纳为护士家， 从事体育锻炼的频率少于没有SMI的同龄同龄人。结果，多发性属性面对 拥有SMI的老年退伍军人大大降低了该人群的独立性和功能。 多组分练习是改善老年退伍军人健康的既定方式，尤其是 有效增加身体功能的所有方面（有氧/耐力，力量，流动性，平衡）。身体的 众所周知，在衰老过程中担心的功能，尤其是随着久坐时间的增加，功能是一个 老年退伍军人与独立性，生活质量，跌倒和 生存。尽管有SMI的老年退伍军人受到了损害，并且锻炼的既定好处 年长的退伍军人，缺乏对这个人群的身体机能和运动的研究。这个职业 开发奖（CDA-1）将通过探索老年退伍军人的功能和体育锻炼来填补这一空白 参加了全国VA支持的临床运动计划Gerofit的SMI。 Gerofit临床数据库 包含基于绩效的身体功能数据，有关平衡，移动性，下半身的强度和 耐力/有氧运动以及有关健康相关生活质量和社会支持的自我报告数据 入学，三个月，六个月和12个月。这些数据已从1,698名老兵收集 从2007年至2019年的11个国家（在17个）国家（在17个）中，其中14％（n = 236）具有SMI。 Gerofit临床 从VA电子健康记录获得的数据库和SMI诊断信息将用于检查 三个目的：（1）表征所有功能中gerofit中具有SMI的老年退伍军人的基线功能 域（平衡，流动性，力量，耐力/有氧运动）将它们与年龄和基于性别的 （2）评估所有领域的一年变化 老年退伍军人在Gerofit中具有SMI的身体功能，并将变化的幅度与老年人进行比较 在Gerofit中没有SMI的退伍军人，（3）检查老年退伍军人的六个月和12个月的Gerofit计划保留 通过SMI状态（SMI与非SMI）比较保留率，并检查了SMI的基线预测指标 保留SMI的老年退伍军人，包括年龄，种族，种族，与健康相关的生活质量，社会支持， 和身体功能。布朗博士的培训计划将有助于完成这些目标和发展 新技能（例如，功能的评估和解释，高级分析技术）和内容知识 （例如，衰老与心理健康的交集，老年退伍军人与SMI的健康促进）。她将参加 在整个奖励期间的教学和专业发展活动中，以支持这些实现 训练目标并从老龄化，SMI，运动，身体机能的专家团队中获得心态 资深健康（凯瑟琳·霍尔（Katherine Hall）博士，米里亚姆·莫雷（Miriam Morey），埃里克·埃尔伯格（Eric Elbogen），金·莫斯（Kim Mueser））。此CDA-1也会产生 随后的CDA-2应用程序的必要试点数据，这将是这项工作的自然扩展。 CDA-1奖是促进布朗博士长期职业目标发展行为的重要第一步 改善生活质量并减少SMI老年退伍军人的多发菌燃烧的干预措施 并将促进健康促进纳入常规临床实践。