Effect of Treatment of Orthostatic Hypotension on a Rehabilitation Unit

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DESCRIPTION (provided by applicant): Project Summary/Abstract 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.