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

Outcomes of a pilot feasibility study of comprehensive geriatric assessment for younger frail patients with severe mental illness

BACKGROUND

Individuals with severe mental illness (SMI) are at risk of early-onset frailty, leading to adverse outcomes. Effective interventions for reducing frailty in this population are currently lacking.

AIMS

To assess the feasibility, acceptability, and preliminary efficacy of Comprehensive Geriatric Assessment (CGA), delivered by an Advanced Trainee in Geriatric Medicine, as an intervention for individuals with co-occurring frailty and SMI.

METHOD

Participants, aged 18-64, with frailty and SMI were recruited from public community outpatient clinics between July 2022 and January 2023. Feasibility of CGA was evaluated through mixed methods. Secondary outcomes included a range of mental and physical health factors.

RESULTS

Out of 38 eligible individuals, 17 were enrolled and 14 completed the study; three dropped out post-baseline assessment and CGA. 86% were male, average age was 48.4, Body Mass Index 34.6, and Frailty Index 0.35. Participants expressed high acceptability and perceived benefits of CGA, including increased insight about one's health and receipt of multidisciplinary holistic care. While this study was inadequately powered to show statistically significant changes in secondary outcomes, positive trends were observed in overall psychosis symptoms and weekly physical activity engagement which increased by 56.6 min, reaching the recommended levels to achieve health benefits.

CONCLUSION

The findings of this study support the feasibility of CGA as an intervention in routine care of people with SMI and provide evidence for designing future trials of frailty interventions in this population. The study underscores the significance of tailored, multidisciplinary, and individualised approaches, though further research is required to substantiate its efficacy in this priority population.

Shared genetic architecture and causal relationship between frailty and schizophrenia

The complex relationship between frailty and schizophrenia has yet to be fully understood. This study aims to clarify their relationship by investigating their genetic links. We hypothesize a shared genetic architecture and a bidirectional causal relationship between the two conditions. Utilizing summary genetic data from European genome-wide association studies, we analyzed genetic associations through global and local correlations, shared genomic loci, tissue enrichments, and functional genes. Bidirectional Mendelian Randomization (MR) was employed to infer causality. Our findings show a positive genetic correlation between frailty and schizophrenia (LDSC: rg = 0.117, p = 6.686 × 10-7; HDL: rg = 0.101, p = 5.63 × 10-13) and local correlations in three genomic regions (chr9: 94167203-96671698, p = 2.21 × 10-6; chr11: 112459488-114257728, p = 1.01 × 10-5; and chr18: 77149991-78017158, p = 9.57 × 10-6). We identified 111 genomic loci associated with both conditions and demonstrated that genetic variants for frailty and schizophrenia share tissue enrichments and functional genes in brain. MR analysis suggests that frailty increases the likelihood of schizophrenia (OR: 1.763, 95% CI: 1.259-2.468, p = 0.001) and vice versa (β: 0.012, 95% CI: 0.006-0.018, p < 0.001). Our research supports the presence of a shared genetic basis and bidirectional causality between frailty and schizophrenia. These findings necessitate further investigation in diverse populations to confirm and expand on this genetic understanding.

Physiotherapy Within Inpatient Mental Health Wards: Involvement, Diagnoses, and Lifestyle Characteristics

BACKGROUND

Severe mental illness (SMI) is often linked to physical health issues, including multiple comorbidities. Physiotherapists are increasingly recognized for their role in addressing these health disparities. This study investigated the role of physiotherapy in managing physical health conditions in individuals admitted to inpatient mental health services.

OBJECTIVE

The primary aim was to examine the prevalence of physical comorbidities among individuals admitted to inpatient mental health services, comparing those referred to physiotherapy versus those not referred. Secondary aims included assessing the relationship between physiotherapy referral and admission duration and identifying patterns in referral likelihood based on primary and comorbid diagnoses.

METHODS

A data linkage analysis was conducted using records from Tees, Esk and Wear Valleys NHS Foundation Trust, encompassing admissions from September 2020 to January 2023. Demographic data, physiotherapy referral status, and SNOMED-CT coded diagnoses were analyzed.

RESULTS

Among 2150 admissions, 505 (23.5%) were referred for physiotherapy. Multimorbidity was present in 58.1% of admissions, with a higher prevalence (67.8%) in those referred to physiotherapy versus those not referred (55.1%). Individuals referred to physiotherapy had longer lengths of stay (117.3 days), compared to those not referred (44.1 days), suggesting that extended stays may indirectly facilitate the identification and management of physiotherapy needs. Referral likelihood was influenced by primary diagnoses and comorbidities.

CONCLUSIONS

Approximately one in four inpatient admissions resulted in a physiotherapy referral, with a higher prevalence of multimorbidity in those referred. Further research is warranted to explore the long-term impacts of physiotherapy interventions on physical and mental health outcomes.

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

Many factors have contributed to rendering frailty an emerging, relevant, and very popular concept. First, many pandemics that have affected humanity in history, including COVID-19, most recently, have had more severe effects on frail people compared to non-frail ones. Second, the increase in human life expectancy observed in many developed countries, including Italy has led to a rise in the percentage of the older population that is more likely to be frail, which is why frailty is much a more common concern among geriatricians compared to other the various health-care professionals. Third, the stratification of people according to the occurrence and the degree of frailty allows healthcare decision makers to adequately plan for the allocation of available human professional and economic resources. Since frailty is considered to be fully preventable, there are relevant consequences in terms of potential benefits both in terms of the clinical outcome and healthcare costs. Frailty is becoming a popular, pervasive, and almost omnipresent concept in many different contexts, including clinical medicine, physical health, lifestyle behavior, mental health, health policy, and socio-economic planning sciences. The emergence of the new "science of frailty" has been recently acknowledged. However, there is still debate on the exact definition of frailty, the pathogenic mechanisms involved, the most appropriate method to assess frailty, and consequently, who should be considered frail. This narrative review aims to analyze frailty from many different aspects and points of view, with a special focus on the proposed pathogenic mechanisms, the various factors that have been considered in the assessment of frailty, and the emerging role of biomarkers in the early recognition of frailty, particularly on the role of mitochondria. According to the extensive literature on this topic, it is clear that frailty is a very complex syndrome, involving many different domains and affecting multiple physiological systems. Therefore, its management should be directed towards a comprehensive and multifaceted holistic approach and a personalized intervention strategy to slow down its progression or even to completely reverse the course of this condition.