For patients recovering from acute illness, the ability to stand, walk, participate in therapy, and climb stairs is critical to their recovery and eventual discharge to the least restrictive environment. Orthostatic hypotension (OH) is one of multiple conditions that contribute to falls, dizziness, syncope, and impaired functional status. In addition, OH is easily identifiable, and is a potentially reversible risk factor. Our preliminary data (collected during our recently completed RRD-funded non-randomized, observational cohort study) show subjects with OH had higher preadmission fall rates, less participation in therapy, less FIM (Functional Independence Measure) gain, and higher mortality after discharge. Also, we determined that approximately 1/3 of all rehabilitation patients were admitted with OH, and that with usual care, this rate did not decrease at discharge. Furthermore, we determined that an interdisciplinary treatment program could reduce discharge OH prevalence. These findings have stimulated this proposed 4 year study that is a randomized control trial directed at the prevention/treatment of OH in subjects admitted to our rehabilitation/nursing home. Predicted enrollment for the 39-month study period is 530 subjects that will be divided into intervention, and control groups of 265 subjects each. The intervention will begin on admission, and continue through discharge. Follow-up assessments will continue for 6 months after discharge. We hypothesize that a multidisciplinary intervention program designed to prevent and treat OH during a nursing home/rehabilitation stay will improve function, outcomes, and prevalence of OH at discharge. In addition, we hypothesize that the treatment protocol will decrease subject fall rates after discharge. This research program will determine if treatment of OH can improve functional status. This improvement could be associated with a reduction of falls, and hip fracture. Even though this proposal is focused on nursing home and rehabilitation patients, its findings should be applicable to the entire Veteran population, including those over 65 who use Rehabilitation Services, younger veterans with chronic diseases, and those with atypical blood pressure disorders (e.g. OIF/OEF veterans with orthostatic intolerance). A major change in how our health system addresses the screening and treatment of orthostatic hypotension would be another example of how the VA is a leader in patient safety and maximizing functional status.
For patients recovering from acute illness, the ability to stand, walk, climb stairs, and participate in therapy are critical to their recovery and eventual discharge to the least restrictive environment. Orthostatic hypotension is a common finding in medically ill adult and elderly patients and is a potentially reversible contributor to functional impairment. This 4-year project will be a randomized controlled trial of a multidisciplinary- multicomponent intervention to determine whether routine identification and treatment of OH improves functional outcomes such as: balance, fall rates, therapy participation, length of stay, transfer to acute care hospital, and discharge location. Routine screening and management of OH may improve outcomes for rehabilitation and long term care patients, as well other high-risk patient populations.
