Advertisement
Regular Research Article|Articles in Press

Physical Function Assessment of Older Veterans With Serious Mental Illness

Published:March 01, 2023DOI:https://doi.org/10.1016/j.jagp.2023.02.048

      Highlights

      • What is the primary question addressed by this study? This study characterized the physical function of older veterans with serious mental illness across endurance, strength, and mobility domains.
      • What is the main finding of this study? Results showed that older veterans with serious mental illness performed worse on measures of endurance, strength, and mobility compared to age- and sex-based references and to their counterparts without serious mental illness.
      • What is the meaning of the finding? Older veterans with serious mental illness have significantly compromised in endurance, strength, and mobility, which may reduce their independence and quality of life.

      ABSTRACT

      Objective

      To characterize the physical function of older veterans with serious mental illness (SMI) across endurance, strength, and mobility domains.

      Design

      Retrospective analysis of clinical performance data.

      Setting

      Gerofit program, a national outpatient supervised exercise program for older veterans, delivered in Veterans Health Administration sites.

      Participants

      Older veterans aged 60 and older (n = 166 with SMI, n = 1,441 without SMI) enrolled across eight national Gerofit sites between 2010 and 2019.

      Measurements

      Performance measures of physical function covering endurance (6-minute walk test), strength (chair stands, arm curls), and mobility (10-m walk, 8-foot-up-and-go), were administered at Gerofit enrollment. Baseline data from these measures were analyzed to characterize the functional profiles of older veterans with SMI. One sample t tests were examined to compare functional performance of older veterans with SMI to age- and sex-based reference scores. Propensity score matching (1:3) and linear mixed effects models were used to evaluate differences in function between veterans with and without SMI.

      Results

      Older veterans with SMI performed worse on all measures of function (chair stands, arm curls, 10-m walk, 6-minute walk test, 8-foot-up-and-go) compared to age- and sex-based reference scores with statistically significant differences present in the male sample. Functional performance of those with SMI was also worse compared to propensity-score matched older veterans without SMI with statistically significant differences on chair stands, 6-minute walk test, and 10-m walk.

      Conclusion

      Older veterans with SMI have compromised strength, mobility, and endurance. Physical function should be a core component of screening and treatment for this population.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Geriatric Psychiatry
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Mokdad AH
        • Ballestros K
        • Echko M
        • et al.
        The state of US health, 1990-2016: burden of diseases, injuries, and risk factors among US states.
        JAMA. 2018; 319: 1444-1472
        • Hjorthøj Stürup AE
        • McGrath JJ
        • Nordentoft MC
        Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis.
        Lancet Psychiatry. 2017; 4: 295-301
        • Vancampfort Firth J
        • Schuch FB
        • Rosenbaum S
        • et al.
        Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis.
        World Psychiatry. 2017; 16: 308-315
        • Bahorik AL
        • Satre DD
        • Kline-Simon AH
        • et al.
        Serious mental illness and medical comorbidities: findings from an integrated health care system.
        J Psychosom Res. 2017; 100: 35-45
        • Chwastiak L
        • Rosenheck R
        • Desai R
        • et al.
        The association of psychiatric illness and all-cause mortality in the national department of veterans affairs health care system.
        Psychosom Med. 2010; 72: 817-822
        • Muralidharan A
        • Klingaman EA
        • Molinari V
        • et al.
        Medical and psychosocial barriers to weight management in older veterans with and without serious mental illness.
        Psychol Serv. 2016; 13: 419-427
        • Caroff SN
        • Leong SH
        • Ng-Mak D
        • et al.
        Socioeconomic disparities and metabolic risk in veterans with serious mental illness community.
        Ment Health J. 2018; 54: 725-734
        • Hendrie HC
        • Hay D
        • Lane K a
        • et al.
        Comorbidity profile and health care utilization in elderly patients with serious mental illnesses.
        Am J Geriatr Psychiatry. 2014; 21: 1-14
        • Miller EA
        • Rosenheck RA
        Risk of nursing home admission in association with mental illness nationally in the department of veterans.
        Affairs Med Care. 2006; 44: 343-351
        • Chafetz L
        • White MC
        • Collins-Bride G
        • et al.
        Predictors of physical functioning among adults with severe mental illness.
        Psychiatr Serv. 2006; 57: 225-231
        • Brooks JM
        • Umucu E
        • Huck GE
        • et al.
        Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain.
        Psychiatr Rehab J. 2018; 41: 224-233
        • Mueser KT
        • Pratt SI
        • Bartels SJ
        • et al.
        Randomized trial of social rehabilitation and integrated health care for older people with severe mental illness.
        J Consult Clin Psychol. 2010; 78: 561-573
        • Bartels SJ
        • Pratt SI
        Psychosocial rehabilitation and quality of life for older adults with serious mental illness: recent findings and future research directions.
        Curr Opin Psychiatry. 2009; 22: 381-385
        • Bartels SJ
        • DiMilia PR
        • Fortuna KL
        • et al.
        Integrated care for older adults with serious mental illness and medical comorbidity: evidence-based models and future research directions.
        Psychiatr Clin North Am. 2018; 41: 153-164
        • Vancampfort D
        • Firth J
        • Schuch FB
        • et al.
        Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis.
        World Psychiatry. 2017; 16: 308-315
        • Cloutier M
        • Aigbogun MS
        • Guerin A
        • et al.
        The economic burden of schizophrenia in the United States in 2013.
        J Clin Psychiatry. 2016; 77: 764-771
        • Chou CH
        • Hwang CL
        • Wu YT
        Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis.
        Arch Phys Med Rehabil. 2012; 93: 237-244
        • Groessl EJ
        • Kaplan RM
        • Rejeski WJ
        • et al.
        Physical activity and performance impact long-term quality of life in older adults at risk for major mobility disability.
        Am J Prev Med. 2019; 56: 141-146
        • Sherrington C
        • Michaleff ZA
        • Fairhall N
        • et al.
        Exercise to prevent falls in older adults: an updated systematic review and meta-analysis.
        Br J Sports Med. 2017; 51: 1749-1757
        • Hardy SE
        • Perera S
        • Roumani YF
        • et al.
        Improvement in usual gait speed predicts better survival in older adults.
        J Am Geriatr Soc. 2007; 55: 1727-1734
        • Dipietro L
        • Campbell WW
        • Buchner DM
        • et al.
        Physical activity, injurious falls, and physical function in aging: an umbrella review.
        Med Sci Sports Exerc. 2019; 51: 1303-1313
        • Bird M
        • Hill KD
        • Ball M
        • et al.
        The long-term benefits of a multi-component exercise intervention to balance and mobility in healthy older adults.
        Arch Gerontol Geriatr. 2011; 52: 211-216
        • Giné-Garriga M
        • Roqué-Fíguls M
        • Coll-Planas L
        • et al.
        Physical exercise interventions for improving performance-based measures of physical function in community-dwelling, frail older adults: a systematic review and meta-analysis.
        Arch Phys Med Rehabil. 2014; 95: 753-769
        • Liu C
        • Latham N
        Progressive resistance strength training for improving physical function in older adults.
        Cochrane Database Syst Rev. 2009; 3: CD002759https://doi.org/10.1002/14651858.CD002759.pub2
        • Zhang Y
        • Zhang Y
        • Du S
        • et al.
        Exercise interventions for improving physical function, daily living activities and quality of life in community-dwelling frail older adults: a systematic review and meta-analysis of randomized controlled trials.
        Geriatr Nurs (Minneap). 2020; 41: 261-273
        • Vancampfort D
        • Rosenbaum S
        • Schuch F
        • et al.
        Cardiorespiratory fitness in severe mental illness: a systematic review and meta-analysis.
        Sport Med. 2017; 47: 343-352
        • Vancampfort Rosenbaum S
        • Ward PB
        • Stubbs BD
        Exercise improves cardiorespiratory fitness in people with schizophrenia: a systematic review and meta-analysis.
        Schizophr Res. 2015; 169: 453-457
        • Vancampfort Rosenbaum S
        • Probst M
        • Soundy A
        • et al.
        Promotion of cardiorespiratory fitness in schizophrenia: a clinical overview and meta-analysis.
        Acta Psychiatr Scand. 2015; 132: 131-143
        • Nygård M
        • Brobakken MF
        • Roel RB
        • et al.
        Patients with schizophrenia have impaired muscle force-generating capacity and functional performance.
        Scand J Med Sci Sport. 2019; 29: 1968-1979
        • Zechner MR
        • Anderson EZ
        • Gill KJ
        Old before their time: comparisons of people with SMI and healthy older adults.
        Psychiatr Rehab J. 2021; 45: 89-94
        • Thorp SR
        • Sones HM
        • Glorioso D
        • et al.
        Older patients with schizophrenia: does military veteran status matter?.
        Am J Geriatr Psychiatry. 2012; 20: 248-256
        • Morey MC
        • Lee CC
        • Castle S
        • et al.
        Should structured exercise be promoted as a model of care? Dissemination of the Department of Veterans Affairs Gerofit Program.
        J Am Geriatr Soc. 2018; 66: 1009-1016
        • Addison O
        • Serra MC
        • Katzel L
        • et al.
        Mobility improvements are found in older veterans after 6 months of Gerofit regardless of body mass index classification.
        J Aging Phys Act. 2019; 27: 848-854
        • Sokal J
        • Messias E
        • Dickerson FB
        • et al.
        Comorbidity of medical illnesses among adults with serious mental illness who are receiving community psychiatric services.
        J Nerv Ment Dis. 2004; 192: 421-427
        • Association AM
        International Classification of Diseases, 9th Revision, Clinical Modification.
        Medicode Publications, Salt Lake City, UT1996
        • Organization WH
        Tenth Revision. International Statistical Classification of Diseases and Related Health Problems. 2. WHO, Geneva, Switzerland1993
        • Arendt M
        • Rosenberg R
        • Foldager L
        • et al.
        Cannabis-induced psychosis and subsequent schizophrenia-spectrum disorders: follow-up study of 535 incident cases.
        Br J Psychiatry. 2005; 187: 510-515
        • Elixhauser A
        • Steiner C
        • Harris DR
        • et al.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Rikli RE
        • Jones CJ
        Development and validation of a functional fitness test for community-residing older adults.
        J Aging Phys Act. 1999; 7: 129-161
        • Peters DM
        • Fritz SL
        • Krotish DE
        Assessing the reliability and validity of a shorter walk test compared with the 10-meter walk test for measurements of gait speed in healthy, older adults.
        J Geriatr Phys Ther. 2013; 36: 24-30
        • Middleton A
        • Fritz SL
        • Lusardi M
        Walking speed: the functional vital sign.
        J Aging Phys Act. 2015; 23: 314-322
        • Rikli RE
        • Jones CJ
        Functional fitness normative scores for community-residing older adults, ages 60-94.
        J Aging Phys Act. 1999; 7: 162-181
        • Hall KS
        • Cohen HJ
        • Pieper CF
        • et al.
        Physical performance across the adult life span: correlates with age and physical activity.
        J Gerontol A Biol Sci Med Sci. 2017; 72: 572-578
        • Kim DH
        • Pieper CF
        • Ahmed A
        • et al.
        Use and interpretation of propensity scores in aging research: a guide for clinical researchers.
        J Am Geriatr Soc. 2016; 64: 2065-2073
        • Austin PC
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Aschbrenner KA
        • Naslund JA
        • Gorin AA
        • et al.
        Group lifestyle intervention with mobile health for young adults with serious mental illness: a randomized controlled trial.
        Psychiatr Serv. 2022; 73: 141-148
        • Vancampfort Rosenbaum S
        • Schuch F
        • Ward PB
        • et al.
        Cardiorespiratory fitness in severe mental illness: a systematic review and meta-analysis.
        Sport Med. 2017; 47: 343-352
        • Bartels Pratt SI
        • Aschbrenner KA
        • Barre LK
        • et al.
        Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes.
        Am J Psychiatry. 2015; 172: 344-352
        • Perera S
        • Patel KV
        • Rosano C
        • et al.
        Gait speed predicts incident disability: a pooled analysis.
        J Gerontol A Biol Sci Med Sci. 2015; 71: 63-71
        • Cesari M
        • Kritchevsky SB
        • Newman AB
        • et al.
        Added value of physical performance measures in predicting adverse health-related events: results from the health, aging and body composition study.
        J Am Geriatr Soc. 2009; 57: 251-259
        • Donoghue OA
        • Savva GM
        • Cronin H
        • et al.
        Using timed up and go and usual gait speed to predict incident disability in daily activities among community-dwelling adults aged 65 and older.
        Arch Phys Med Rehabil. 2014; 95: 1954-1961
        • Yazdanyar A
        • Aziz MM
        • Enright PL
        • et al.
        Association between 6-minute walk test and all-cause mortality, coronary heart disease-specific mortality, and incident coronary heart disease.
        J Aging Health. 2014; 26: 583-599
        • Bartels S
        Caring for the whole person: integrated health care for older adults with severe mental illness and medical comorbidity.
        J Am Geriatr Soc. 2004; 52: S249-S257
        • Peterson MJ
        • Crowley GM
        • Sullivan RJ
        • et al.
        Physical function in sedentary and exercising older veterans as compared to national norms.
        J Rehabil Res Dev. 2004; 41: 653-658
        • Stubbs Williams J
        • Gaughran F
        • Craig TB
        How sedentary are people with psychosis? A systematic review and meta-analysis.
        Schizophr Res. 2016; 171: 103-109