Peer Support for Exercise in Older Veterans with Psychotic Disorders
Project Number1IK2RX002339-01A1
Contact PI/Project LeaderMURALIDHARAN, ANJANA
Awardee OrganizationBALTIMORE VA MEDICAL CENTER
Description
Abstract Text
Anticipated Impacts on Veteran’s Healthcare: Older Veterans with psychotic disorders face unique barriers to
engagement in health-promoting activities, including prototypical features of psychosis (e.g., negative
symptoms, medication side effects) and exacerbating features of the aging process (e.g., increased medical
comorbidity, declines in musculoskeletal health). It is critical to develop strategies to empower this group to
overcome these barriers and engage in health behaviors that can improve their functioning and quality of life.
Peer interventions, or interventions delivered by individuals who are similar to a patient population on some
characteristic such as age or diagnosis, effectively promote engagement in health behaviors in a range of
populations. Despite the promise of peer support and urgent needs of older adults with psychosis, there are no
well-specified peer support interventions that promote participation in health behaviors and are tailored to the
needs of this group. The present study will yield a well-specified group-based peer coaching intervention, to be
delivered by VA Peer Specialists (Veterans in recovery from mental illness), targeted to empower older
Veterans with psychosis to overcome barriers, increase exercise/physical activity, and improve functioning.
Project Background: Over the next two decades, Veterans with psychotic disorders (i.e., schizophrenia
spectrum disorders and affective psychoses) will age into older adulthood in unprecedented numbers. The
challenges of treating this growing population and associated high costs will have profound implications for
VHA. Older adults with psychotic disorders exhibit diminished physical and psychosocial functioning and are at
increased risk for rapid functional decline and early institutionalization in nursing homes. Participation in
structured exercise delays functional disability in older adults; however, older adults with psychosis exhibit low
exercise participation. While peer-delivered exercise interventions for older adults promote initiation and
maintenance of exercise and physical activity, there are no peer-delivered exercise interventions tailored to the
unique needs of older adults with psychosis. The present study aims to fill this critical gap.
Project Objectives: This study will develop and pilot test a well-specified, group-based peer coaching
intervention tailored to the unique needs of older Veterans with psychotic disorders: Peer Education on
Exercise for Recovery (PEER). PEER will provide intensive coaching from a VA Peer Specialist to promote
participation in a supervised fitness training program for older Veterans. To develop the intervention, materials
from existing peer-delivered wellness interventions for Veterans with serious mental illness will be tailored for
older Veterans with psychosis, through an iterative process synthesizing the extant literature and pilot data,
developing draft materials, and obtaining feedback from a multidisciplinary panel of expert mentors/consultants
and Peer Specialists/Veteran consumers. A small open trial of PEER will be conducted with 6 older Veterans
with psychotic disorders (ages 50 and up); qualitative interviews will explore participants’ perceptions of PEER.
Finally, a pilot randomized controlled trial (RCT) of PEER will be conducted. Older Veterans with psychotic
disorders (ages 50 and up, n=50) will be enrolled in supervised fitness training and randomized to receive
group-based peer coaching (the PEER condition) or individual support from non-peer staff (the enhanced
supervised fitness training (ESFT) condition). Feasibility of PEER (rates of recruitment, intervention
engagement, and peer coach fidelity) will be measured. The impact of PEER versus ESFT on attendance of
exercise sessions, levels of physical activity, and physical functioning will be examined. Additionally, the PI will
engage in training activities to develop expertise in the functional rehabilitation of older adults with psychosis.
Project Methods: This project will include developing intervention materials for PEER, conducting an open trial
of PEER in a small sample, and completing a small RCT. We will monitor acceptability and feasibility; study
Veterans’ experiences; and measure exercise/physical activity behaviors and functional outcomes.
Public Health Relevance Statement
Older adults with psychotic disorders experience a dual set of challenges: those related to serious mental
illness, and those related to aging. They have medical, cognitive, psychological and social difficulties; as a
result they have an almost four times greater likelihood of early institutionalization in nursing homes. These
challenges make it difficult for this group to engage in health behaviors, such as exercise. This is unfortunate,
since participation in health-promoting activities is essential for maintaining functional independence with age.
This study aims to develop and pilot test a peer coaching intervention for older Veterans with psychotic
disorders, in which VA Peer Specialists, who are Veterans in recovery from mental illness, will provide
intensive coaching to older Veterans with psychotic disorders to promote their participation in exercise and
physical activity. Results from this study will inform us as to whether this intervention is acceptable to Veterans,
feasible to implement, and effective in increasing exercise, physical activity, and physical fitness/function.
No Sub Projects information available for 1IK2RX002339-01A1
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