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. 2022 Mar;70(3):880-890.
doi: 10.1111/jgs.17674. Epub 2022 Feb 4.

Implementation of a rehabilitation model in a Program of All-Inclusive Care for the Elderly (PACE): Preliminary data

Allison M Gustavson  1   2 , Cherie V LeDoux  1 , Michael Himawan  1 , Jennifer E Stevens-Lapsley  1   3 , Kathryn A Nearing  3   4   5
Affiliations

Implementation of a rehabilitation model in a Program of All-Inclusive Care for the Elderly (PACE): Preliminary data

Allison M Gustavson et al. J Am Geriatr Soc. 2022 Mar.

Abstract

Background: Nursing home eligible participants in the Program of All-inclusive Care for the Elderly (PACE) are at high risk for falls. Physical function is a modifiable predictor of falls and an important target for prevention. We engaged a PACE site to explore feasibility of implementing progressive intensive rehabilitation to improve physical function and preliminary patient-level improvements.

Methods: The research involved a mixed-methods, pre-post implementation study with longitudinal patient follow-up at one Denver PACE site. Older adults at risk for institutionalization (N = 28) took part in Screening and high-intensity interventions to Improve Falls risk and Transform expectations in age and aging (SHIFT) rehabilitation program over six weeks. Outcomes included the short physical performance battery (SPPB); 4-meter gait speed at baseline, discharge, and 6 and 12 months postdischarge from SHIFT. A focus group with staff explored facilitators and barriers to program implementation in the PACE setting and with complex patients and perceived effectiveness.

Results: The rehabilitation team demonstrated high treatment fidelity to SHIFT (>80%). No treatment-specific adverse events were reported. SPPB scores and gait speeds improved significantly over time (p < 0.005). The average SPPB score at evaluation was 4.6 ± 0.24 compared to 7.7 ± 0.38 points at discharge. The average gait speed at evaluation was 0.58 ± 0.03 meters/second (m/s) compared to 0.79 ± 0.04 m/s at discharge. Common barriers to program completion included changes in health status and environmental factors (e.g., transportation).

Conclusions: Rehabilitation therapists incorporated a high-intensity resistance training program into routine care of complex older adults in PACE and improved pre-post physical function to levels above independence thresholds (SPPB ≥6; gait speed ≥0.65 m/s). Our pilot implementation study informed refinement of eligibility criteria, number of visits, and strategies to address long-term adherence to enhance scalability and optimize impact.

Keywords: fall risk; physical function; program of all-inclusive care for the elderly; progressive rehabilitation.

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References

REFERENCES

    1. Mui AC. The program of all-inclusive Care for the Elderly (PACE): an innovative long-term care model in the United States. J Aging Soc Policy. 2001;13(2-3):53-67.
    1. InnovAge. Available at: http://www.myinnovage.org/. Accessed November 1, 2021.
    1. Friedman SM, Steinwachs DM, Rathouz PJ, Burton LC, Mukamel DB. Characteristics predicting nursing home admission in the program of all-inclusive care for elderly people. Gerontologist. 2005;45(2):157-166.
    1. Eng C, Pedulla J, Eleazer GP, McCann R, Fox N. Program of all-inclusive Care for the Elderly (PACE): an innovative model of integrated geriatric care and financing. J Am Geriatr Soc. 1997;45(2):223-232.
    1. Wysocki A, Butler M, Kane RL, Kane RA, Shippee T, Sainfort F. Long-term services and supports for older adults: a review of home and community-based services versus institutional care. J Aging Soc Policy. 2015;27(3):255-279.

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