Comprehensive Geriatric Assessment for younger outpatients with severe mental illness: protocol for a feasibility study

Abstract

IntroductionIndividuals with severe mental illness are at risk of becoming prematurely frail. There is a critical unmet need for an intervention that reduces the risk of frailty and minimises the associated negative outcomes in this population. This study aims to provide novel evidence on the feasibility, acceptability and preliminary effectiveness of Comprehensive Geriatric Assessment (CGA) to improve health outcomes among people with co-occurring frailty and severe mental illness.Methods and analysisTwenty-five participants with frailty and severe mental illness, aged 18–64 years, will be recruited from Metro South Addiction and Mental Health Service outpatient clinics and provided with the CGA. Primary outcome measures will include the feasibility and acceptability of the CGA embedded in routine healthcare. Other variables of interest will include frailty status, quality of life, polypharmacy, and a range of mental and physical health factors.Ethics and disseminationAll procedures involving human subjects/patients were approved by Metro South Human Research Ethics Committee (HREC/2022/QMS/82272). Study findings will be disseminated through peer-reviewed publications and conference presentations.

Prevalence of frailty in severe mental illness: findings from the UK Biobank

“…Additionally, pilot feasibility studies of frailty-focused interventions in people with SMI would be critical in informing the development of frailty interventions for people with SMI who are frail. 39 …”

“…[35][36][37] Although frailty interventions have been found to be effective in populations with various medical conditions, 38 there have been limited frailty intervention studies in those with SMI. 39 Frailty interventions frequently combine exercise, nutrition, medical and pharmacological review, the importance of which are all well appreciated by those caring for people with SMI. Where the concept of frailty in the context of people with SMI, when measured by a tool such as the frailty index, may be particularly beneficial is to capture a more comprehensive account of an individual's functioning and health.…”

“…Additionally, pilot feasibility studies of frailty-focused interventions in people with SMI would be critical in informing the development of frailty interventions for people with SMI who are frail. 39 Regardless of how frailty in operationalised or when it is assessed, the prevalence of frailty appears to be significantly higher in people with SMI than in those without, and it remains elevated throughout life. Frailty can be a more holistic measure, capturing a wide range of deficits and placing an individual on a continuum that can be monitored over time and compared against general population norms.…”

To Be Frail or Not to Be Frail: This Is the Question—A Critical Narrative Review of Frailty

“…Emerging evidence suggests that people with SMI are associated with multiple medical comorbidities, such as cardiovascular disease and metabolic syndrome, poorer functional status, cognitive deficits, falls, weak muscle strength, and mortality [342,395,396]. People living with severe mental disorders have an average life expectancy that is 15 years lower than those without mental disorders and have an elevated level of frailty [397]. Frailty in the context of severe mental disorders can be defined as a state of vulnerability and physical decline associated with an elevated prevalence of somatic comorbidities (up to twice that of the general population) and premature mortality compared with the general population, mostly through preventable physical causes [326,398].…”

“…All these factors eventually contribute to physical health problems, obesity, cardiovascular issues, diabetes, and cognitive decline, which are all characteristics of frailty. Those aspects are further influenced by stigma and limited access to healthcare services, high rates of psychosocial stressors, including homelessness, unemployment, loneliness, lack of social support and social instability, and the fact that some people may struggle with maintaining a healthy lifestyle due to their symptoms, limited motivation, or cognitive impairments [397]. This can lead to poor lifestyle choices, including a lack of exercise, poor diet, smoking, and the neglect of their physical health.…”