Improving Function in Older Veterans With Hospital-Associated Deconditioning

Hospital associated deconditioning is a common and profound contributor to functional decline
in older adults. Skeletal muscle weakness and atrophy are commonly observed in older adults
with deconditioning after a hospitalizations, leading to chronic functional deficits. This is
especially concerning for elderly Veterans, a population who tends to suffer from more
chronic conditions and have decreased physical function than the general older adult
population. Therefore, Veterans may be at even higher risk for developing disability in
activities of daily living after hospitalization and be homebound. Home health physical
therapy may be the ideal venue for addressing this functional decline as around 3 million
older adults receive home health services following hospital discharge. These services,
however, tend to be low intensity and do not appear to adequately address deficits in
function or performance of home and community mobility. To address these concerns, the
investigators have developed and tested an innovative, short-duration, home-based, high
intensity exercise program designed for application immediately following hospitalization.
This protocol will dose twelve therapy visits over the course of 30 days to determine whether
visit frontloading has any effect on outcomes. The investigators are using a series of high
resistance therapy exercises following acute hospitalization to determine if progressive high
intensity therapy sustainability improves physical function more than standard home health
physical therapy after an acute hospitalization in older Veterans. Outcomes will spotlight
physical function, community mobility, Activities of Daily Living, quality of life, and
cognition.

Inclusion Criteria:

- Veteran Status

- Referred to or eligible for home health physical therapy

- Have at least 3 comorbid conditions including: Chronic Obstructive Pulmonary Disease
(COPD), pneumonia, hypertension, hernia, heart disease, spinal stenosis, atrial
fibrillation, post-op bowel surgery, gastrointestinal bleed, chronic ulcerative
wounds, depression/ mental health, post-op pancreatic surgery, hypercholesterolemia,
dehydration, hypo/hyperthyroid, congestive heart failure, urinary tract infection,
diabetes, irritable bowel syndrome, osteoporosis, osteoarthritis, rheumatoid
arthritis, gout, peripheral artery disease, syncope, renal failure-no dialysis

- Be ambulatory without human assistance prior to hospitalization

Exclusion Criteria:

- Acute lower extremity fracture with weight-bearing restriction

- Elective joint replacement surgery

- Lower extremity amputation

- Acute cardiac surgery

- Terminal illness

- Cancer

- Alzheimer's disease

- Deep vein thrombosis

- Recent stroke

- Degenerative neurological conditions

- Gait speed slower than 0.3 m/s or >1.0 meters/second

- Inability to walk 10 feet without human assistance --History of illegal substance use