Innovative Interprofessional Approaches to Improving Well Being for Older Adults with Interacting Mental and Physical Health Concerns

Fellow Clinical Gerontologists, we are excited to begin this issue with a review paper concerning companion animals and health in older adults that I expect will be of great interest to many, judging by the large number of times it has already been viewed on our online site (Hughes, Verreynne, Harpur, & Pachana, 2019). This review considers 52 studies finding companion animals to have positive effects on mental health, such as quality of life and symptoms of depression and anxiety, as well as some effects on physical health, such as physical activity and cardiac health markers.

We continue in this issue of the journal to consider relationships between mental health and physical function, beginning with two studies focused on falling. Thiamwong and colleagues (Thiamwong et al., 2019) compare older adults (N = 19, M age 76) assigned to a fall risk program versus to an education only control group (N = 22, M age 78). The program uses cognitive therapy to address the incongruence of fall risk appraisal with physiological fall risk measures. This cognitive work is paired with an exercise intervention. The program was effective in shifting fall risk appraisal and fall risk. While awaiting replication in a larger sample, this study points to the value of direct assessments of function and approaches that combine interprofessional expertise – such as the expertise of mental health professionals and exercise professionals. Relatedly, Soleimani and colleagues (Soleimani, Jalali, & Mirbolook, 2019) compare 44 older adults who received surgical intervention for femoral or trochanteric fracture after a fall (M age 71) to 44 controls (M age 70). Not surprisingly, those who had fallen had more fear of falling again. Interestingly, in multiple regression, fear of falling was associated with problems with balance and dizziness, but not anxiety and quality of life in multiple regression. This study again highlights the benefits of interprofessional approaches to research and clinical care to detangle fall risk from fear of falling.

The next three studies are descriptive and similarly point to the utility of direct assessment of function. A study of older adults enrolled in outpatient mental health (N = 147, M age 72) (Anantapong, Wiwattanaworaset, & Sriplung, 2020) combined a direct assessment of function (gait speed and grip strength) with assessment of weight loss, exhaustion, and low physical activity. Here, depression predicted function along with education, social support, and caregiver need. A similar study of community dwelling older adults (N = 78, M age 72) (Morin, Insel, Bickford, Nelson, & Mackin, 2019) (N = 78, M age 72) used a direct assessment of function (gait speed, grip strength, and grooved pegboard). Here again, depression was key in predicting disability. A third study (Gogniat et al., 2020) assessed functional ability in multiple ways (N = 131, M age 74) and found that personality factors were related to self-reported function, but not performance based measures of function. Together these papers reinforce the value of direct measures of function, such as gait speed. For the mental health clinician, gait speed is a relatively easy measure to incorporate in the walk from a waiting room to an office, by timing speed over distance (often 4 meters), and looking for slowed pace (e.g., less than .8 m/s) (Peel, Kuys, & Klein, 2013).

Relationships between physical and mental wellbeing are complex and often interactive. The next paper is a study of older adults enrolled in treatment for depression (N = 51, M age 70) for whom cortisol levels predicted functional status assessed through both observation and self-report (Shindel, Holland, & Gallagher-Thompson, 2019). This is followed by a paper which examines older adults in two primary care clinics in Malaysia (N = 271, M age 68) (Samy, Kamaruzzaman, Krishnaswamy, & Low, 2019) for whom depression predicted lower physical quality of life in those with MCI, with different predictors for other quality of life domains. Yet another paper uses a national survey of older adults (N = 6,945, M age 77) (Wang & Kim, 2019) to show that those with physical and mental comorbidities had the lowest subjective wellbeing.

Our two final articles return to fear of falling. The first paper examines racial differences in a national survey of older adults (N = 4,981) (Singh, Belanger, & Thomas, 2018). The closing paper is a case series demonstrating application of many of the concepts in this issue (Cappleman & Thiamwong, 2019). In these cases, feedback from physiological measures was helpful in addressing fear of falling, particularly a lack of congruence between fear and physiological fall risk. Taken together these papers expand our knowledge about how to intervene to help older adults whose mental and physical health concerns interact.

Disclosure statement

No potential conflict of interest was reported by the author.