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

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.

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.

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).

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.