Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic

Authors

Alexander J. Garbin, VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
Frank DeVone, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Thomas A. Bayer, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Jennifer Stevens-Lapsley, VA Eastern Colorado Geriatric Research, Education, and Clinical Center (GRECC), VA Eastern Colorado Health Care System, Aurora, CO, USA; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO, USA.
Yasin Abul, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA.
Mriganka Singh, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA.
Ciera Leeder, Rochester Regional HealthFollow
Christopher Halladay, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Kevin W. McConeghy, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA.
Stefan Gravenstein, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.
James L. Rudolph, Center of Innovation in Long Term Services and Supports (LTSS-COIN), Providence VA Medical Center, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA; Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, USA.

Department

Medicine

Document Type

Article

Publication Title

Journal of the American Medical Directors Association

Abstract

OBJECTIVES: Examine physical function change and physical therapy (PT) use in short-stay and long-stay residents not infected by CoVID-19 within Veterans Affairs (VA) Community Living Centers (CLCs).

DESIGN: Retrospective cohort study using Minimum Data Set (MDS) 3.0 assessments.

SETTINGS AND PARTICIPANTS: 12,606 Veterans in 133 VA CLCs between September 2019 and September 2020.

METHODS: Difference in physical function [MDS Activities of Daily Living Score (MDS-ADL)] and PT use (minutes in past 7 days) from admission to last assessment in a period were compared between the pre-CoVID-19 (September 2019 to February 2020) and early CoVID-19 (April 2020 to September 2020) period using mixed effects regression with multivariable adjustment. Assessments after a positive CoVID-19 test were excluded. Differences were examined in the sample and repeated after stratifying into short- and long-stay stratums.

RESULTS: Veterans admitted during early CoVID-19 had more comorbidities, worse MDS-ADL scores, and were more often long-stay residents compared with those admitted during pre-CoVID-19. In comparison to pre-CoVID-19, Veterans in VA CLCs during early CoVID-19 experienced greater improvements in their MDS-ADL (-0.49 points, 95% CI -0.27, -0.71) and received similar minutes of therapy (2.6 minutes, 95% CI -0.8, 6.0). Stratification revealed short-stay residents had relative improvements in their function (-0.69 points, 95% CI -0.44, -0.94) and higher minutes of PT (5.1 minutes, 95% CI 0.9, 9.2) during early CoVID-19 whereas long-stay residents did not see differences in functional change (0.08 points, 95% CI -0.36, 0.51) or PT use (-0.6 minutes, 95% CI -6.1, 4.9).

CONCLUSIONS AND IMPLICATIONS: During early CoVID-19, physical function improved while the amount of PT received was maintained compared with pre-CoVID-19 for Veterans in VA CLCs. Short-stay residents experienced greater improvements in physical function and increases in PT use. These findings may be partly due to selection bias relating to Veterans admitted to CLCs during early CoVID-19.

First Page

105120

DOI

10.1016/j.jamda.2024.105120

Volume

25

Issue

9

Publication Date

9-1-2024

Medical Subject Headings

Humans; COVID-19 (epidemiology); Male; Female; Aged; Veterans; Retrospective Studies; United States (epidemiology); Physical Therapy Modalities; Activities of Daily Living; SARS-CoV-2; Aged, 80 and over; Pandemics; United States Department of Veterans Affairs

PubMed ID

38945171

Recommended Citation

Garbin, A. J., DeVone, F., Bayer, T. A., Stevens-Lapsley, J., Abul, Y., Singh, M., Leeder, C., Halladay, C., McConeghy, K. W., Gravenstein, S., & Rudolph, J. L. (2024). Changes in Physical Function and Physical Therapy Use in Older Veterans Not Infected by CoVID-19 Residing in Community Living Centers during the CoVID-19 Pandemic. Journal of the American Medical Directors Association, 25 (9), 105120. https://doi.org/10.1016/j.jamda.2024.105120