There is a growing recognition that acute hospitalization contributes to long-term disability for hospitalized older adults-who are 60 times more likely to develop disability than those who are not hospitalized. Older Veterans are particularly vulnerable to functional decline after hospitalization, as this population has lower function and more comorbidities than age-matched peers. Home Health (HH) physical therapy may be the ideal venue for addressing these mobility deficits. However, as currently structured, these services do not appear to adequately address deconditioning often resulting from acute hospitalization as evidenced by poor functional recovery, and poor community and home mobility, up to 2 years after acute hospitalization. A more intensive approach to HH physical therapy delivered within the immediate post-hospitalization period in older Veterans has great potential to maximize physical function, home and community mobility, and quality of life. Therefore, we have developed a short duration, progressive high intensity therapy (PHIT) intervention that directly addresses the functional deficits seen after acute hospitalization. We propose to conduct a two-arm, randomized clinical trial (RCT) of 150 older adults with hospital-associated deconditioning, discharged from acute care and referred to HH physical therapy. Participants will receive either 1) an intensive, PHIT intervention using resistance exercise and evidenced- based motor control training to improve mobility or 2) usual care (UC) physical therapy. The primary goal of this investigation is to determine if PHIT intervention, initiated upon hospital discharge, improves functional mobility more than UC physical therapy. Secondary goals include evaluation of quality of life, life-space mobility, ADL performance, and caregiver burden. Treatment will occur at home during the first 30 days following hospital discharge with testing at: baseline (after hospita discharge), 30 days, 60 days (primary endpoint), 90 days, and 180 days after hospitalization. If successful in improving patient function, PHIT intervention holds potential for future health care cost savings by reductions in the need for formal caregiving services and institutionalization in the older Veteran population.
This study focuses on a prevalent and understudied problem for older Veterans: functional decline following acute hospitalization. Our proposed intervention is designed to be applied in the immediate post- hospitalization period to ameliorate the effects of deconditioning for older Veterans, and improve home and community mobility. The intervention also has potential to reduce utilization of high-cost long-term healthcare options such as use of formal in-home caregivers or institutionalization within the Veterans Health Administration System.
|Gustavson, A M; Falvey, J R; Jankowski, C M et al. (2017) Public Health Impact of Frailty: Role of Physical Therapists. J Frailty Aging 6:2-5|