ENHANCED MEDICAL REHABILITATION FOR OLDER ADULTS

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DESCRIPTION (provided by applicant): For millions of disabled older adults each year, post-acute rehabilitation in skilled nursing facilities (SNFs) is a narrow window of opportunity to regain enough function to return home and live independently -- but all too often they fail due to problems such as depression that undermine rehabilitation's benefits. Therefore, we created Enhanced Medical Rehabilitation (EMR) for older adults. A real-world adaptation of the science of behavior change, EMR is an integrated set of skills for physical and occupational therapists (PT/OT) that transform standard post-acute rehabilitation through: (1) a patient-directed, interactive approach (2) increased rehabilitation intensity (3) frequent feedback to patients on effort and progress. We developed training and supervision techniques so that PT/OTs carry out these skills with high treatment integrity. In NIMH R34 pilot work, we found: (1) EMR is high-intensity and engaging: therapy by PT/OTs trained and supervised in EMR is greatly amplified in intensity and patient engagement compared to standard-of-care rehabilitation. (2) EMR improves functional and affective recovery: patients randomized to EMR had better improvement of function, physical performance, and positive and negative affect. (3) EMR overcomes barriers to rehabilitation: patients with depressive symptoms, cognitive impairment, and multiple medical comorbidities benefitted most from EMR relative to standard therapy. We propose a randomized trial that will test EMR's benefits over standard-of-care rehabilitation for affective and functional recovery. Our aims are (1) examine the effectiveness of EMR for improving functional and affective outcomes in 252 older adults admitted to SNFs for post-acute rehabilitation, and (2) examine EMR's ability to overcome patient-level barriers (such as depression) to successful rehabilitation. The innovation of this project is high: it is a novel application of theories of behavior change to improve both affect and function. It responds to NIMH strategic plan objective 3, "Develop new and better interventions for mental disorders that incorporate the diverse needs and circumstances of people with mental illness." The public health significance is also high: recovery from disablement is a health issue of enormous human and economic significance. Success in this line of research will make rehabilitation more effective. Doing so would benefit all older adults in this sector of care but particularly those wih depression, cognitive impairment, and other complications. This project addresses NIMH's goal of interventions to improve mental health and related health outcomes in real-world settings.