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.

Public Health Relevance

Multiple morbidity is an increasingly common occurrence among older adults, with consequences seen across health behaviors, functional ability, and quality of life. The added burden of post traumatic stress disorder (PTSD) on behavioral and functional outcomes. In older Veterans, the added burden of comorbidities is unclear, but preliminary findings suggest that PTSD has a negative impact on the ability to alter lifestyle behaviors in a positive manner. This study aims to examine the impact of PTSD on adherence to an ongoing 12-month physical activity intervention in an effort to develop cognitive-behavioral interventions to increase physical activity and maintain/restore function in older Veterans with multiple comorbidities + PTSD.

National Institute of Health (NIH)
Veterans Affairs (VA)
Veterans Administration (IK1)
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Durham VA Medical Center
United States
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Hall, Katherine S; Beckham, Jean C; Bosworth, Hayden B et al. (2014) PTSD is negatively associated with physical performance and physical function in older overweight military Veterans. J Rehabil Res Dev 51:285-95
Hall, Katherine S; Howe, Cheryl A; Rana, Sharon R et al. (2013) METs and accelerometry of walking in older adults: standard versus measured energy cost. Med Sci Sports Exerc 45:574-82