. 2022 Mar 29;37(Suppl 1):22–32. doi: 10.1007/s11606-021-07076-x

Table 2.

GRECC Initiatives Promoting Physical Functioning in Older Veterans, OVET Feedback, and Impact 2018–2020

Initiatives (guest)	OVET feedback, response, and current status
Coaching to support walking in Veterans with lower limb amputation (GRECC Advanced Research Fellow) April 2018	• OVET feedback: Coaching should encourage social support and environments enjoyable for walking. There are different motivations for initiating versus maintaining walking (or any exercise). Need to tailor coaching accordingly. • Guest response: Refined grant, submitted to NIH • Related outcome: Application funded in 2019 by the National Institute of Nursing Research (Total 5-year direct cost: $1,250,000; total direct/indirect: $1,942,000)
Walk with Ease program (GRECC Advanced Research Fellow) May 2018	• OVET feedback: Major barrier to participating in regular exercise program: inconvenience of travel (drive time and traffic) • Response: Added a home-based exercise component. Extended center-based exercise program hours from mid-morning to mid-afternoon (accommodated those who prefer to exercise in morning/afternoon; also avoided rush hour traffic). • Related outcomes: Original application not funded; resubmitted June 2021.
Promoting intensive, progressive physical therapy (doctoral student) January 2019	• OVET feedback: Noted times when providers could have pushed patients more; shared ideas about ways to make PT more fun/engaging; emphasized importance of helping patients set goals or challenge themselves. Asking about pain can make pain seem worse/direct attention toward it. Instead, ask about mood or tolerance for continuing an activity. • Response: Documented in case example in text. • Related outcome: OVET feedback informed two successful applications: a VA Office of Rural Health-funded project titled, “Improving Physical Rehabilitation for Rural Veterans with Complex Care Needs“ ($168,153) and a VA SPIRE award ($228,500) from RR&D
Establishing a Fall Prevention Clinic at the RMR VAMC (GRECC Advanced Research Fellow) June 2019	• OVET feedback: Make Fall Prevention Clinic interdisciplinary (e.g., include pharmacist and podiatrist); staff with providers knowledgeable about conditions more prevalent in Veterans that can increase fall risk (e.g., TBI). • Response: New clinic staffed with a team including a geriatrician, geriatric PT, OT, and geriatric pharmacist. Linked with other programs (e.g., Gerofit) to support fall prevention, enhanced mobility, and independence. Exploring the ability to partner with podiatry. • Outcome: New Fall Prevention Clinic opened in May 2021 after delay due to COVID-19.
Aging Veteran Surgical Wellness Program (GRECC Advanced Research Fellow) January 2020	• OVET feedback: Engage caregivers as point person for coordinating care with surgical wellness team, including follow-up telehealth appointment after Veteran returns home, and learning/managing associated technological aspects. Validated need to include a pharmacist on surgical wellness team. Encouraged scheduling telehealth check within 2 days of returning home (rather than the 3 days proposed). • Response: Refined and implemented program with eight patients before elective surgical procedures were halted due to COVID-19. Continuity of care achieved by interprofessional team who conducts pre-operative assessment to identify vulnerabilities in this population before surgery and provides telehealth follow-up to improve surgical outcomes. Currently analyzing data to assess the impact on ED visits and rehospitalization. • Outcome: As a result of this project, RMR VAMC was the first VA to be designated as a Level 1 Geriatric Surgery Center of Excellence.
Tele-rehabilitation Program (doctoral student) June 2020	• OVET feedback: Help Veterans set goals and monitor progress. Meaningful goals are tied to activities that contribute to the quality of life (e.g., dancing, gardening, playing with grandchildren). Social connection/social support is really important. Create teams with a team leader who would help motivate and generate friendly competition. • Response: Included activity tracking and providing feedback to Veterans regarding progress. Included caregivers to enhance social support and safety. Based on OVET suggestions, will develop training to help caregivers feel more confident and comfortable. Still exploring ways to promote social connections effectively in virtual group exercise sessions; program participant feedback has validated the importance of OVET suggestions in this regard. • Outcome: VA Office of Connected Care project, “Tele-rehabilitation for Medically Complex Veterans During the COVID-19 Pandemic” funded October 2020 ($169,130)
Emergency Department Weight Management and Exercise Prescription Program – Using ED visits to counsel and connect to services (Emergency Medicine physician, RMR VAMC) October 2020	• OVET feedback: Veteran may be in pain, scared, or disoriented and unable to focus on handouts, videos, or even in-person explanations of exercise programs. Offer interactive discussion at ED discharge, after acute needs/concerns have been addressed. Physician can link exercise and weight management to relieving pain. • Response: Refined interview guides for patients and providers to include questions re: discharge discussion, including pain management. Created succinct handout with phone numbers for follow-up questions and other VA resources for Veteran to utilize at home. Updated ED discharge instructions to include information regarding transitions of care (i.e., connections to post-ED visit services). • Outcome: Study in progress
Effects of exercise on bone health (Advanced Research Fellow planning grant resubmission) November 2020	• OVET feedback: Members reviewed research protocol, shared perspectives re: feasibility and burden of participation. Shared that exercise and blood draw requirements would not necessarily be a deterrent (a reviewer concern). However, number of visits and time required may be challenging. Recommended home visits for 24 and 48-hour blood draws and flexibility in scheduling. • Response: Reviewers of original proposal expressed concerns regarding tolerance of study participants for exercise regime or required blood draws. OVET members indicated tolerance for both. Based on OVET suggestions, fellow budgeted for home visits for 24 and 48-hr blood draws and to accommodate providing health information (like cholesterol panel) to increase benefits associated with participation. OVET provided signed Letter of Support noting the importance of the proposed research to older Veterans. • Outcome: VA Career Development Award resubmitted December 2020.

Initiatives (guest)

OVET feedback, response, and current status

Coaching to support walking in Veterans with lower limb amputation (GRECC Advanced Research Fellow)

April 2018

• OVET feedback: Coaching should encourage social support and environments enjoyable for walking. There are different motivations for initiating versus maintaining walking (or any exercise). Need to tailor coaching accordingly.

• Guest response: Refined grant, submitted to NIH

• Related outcome: Application funded in 2019 by the National Institute of Nursing Research (Total 5-year direct cost: $1,250,000; total direct/indirect: $1,942,000)

Walk with Ease program (GRECC Advanced Research Fellow)

May 2018

• OVET feedback: Major barrier to participating in regular exercise program: inconvenience of travel (drive time and traffic)

• Response: Added a home-based exercise component. Extended center-based exercise program hours from mid-morning to mid-afternoon (accommodated those who prefer to exercise in morning/afternoon; also avoided rush hour traffic).

• Related outcomes: Original application not funded; resubmitted June 2021.

Promoting intensive, progressive physical therapy (doctoral student)

January 2019

• OVET feedback: Noted times when providers could have pushed patients more; shared ideas about ways to make PT more fun/engaging; emphasized importance of helping patients set goals or challenge themselves. Asking about pain can make pain seem worse/direct attention toward it. Instead, ask about mood or tolerance for continuing an activity.

• Response: Documented in case example in text.

• Related outcome: OVET feedback informed two successful applications: a VA Office of Rural Health-funded project titled, “Improving Physical Rehabilitation for Rural Veterans with Complex Care Needs“ ($168,153) and a VA SPIRE award ($228,500) from RR&D

Establishing a Fall Prevention Clinic at the RMR VAMC (GRECC Advanced Research Fellow)

June 2019

• OVET feedback: Make Fall Prevention Clinic interdisciplinary (e.g., include pharmacist and podiatrist); staff with providers knowledgeable about conditions more prevalent in Veterans that can increase fall risk (e.g., TBI).

• Response: New clinic staffed with a team including a geriatrician, geriatric PT, OT, and geriatric pharmacist. Linked with other programs (e.g., Gerofit) to support fall prevention, enhanced mobility, and independence. Exploring the ability to partner with podiatry.

• Outcome: New Fall Prevention Clinic opened in May 2021 after delay due to COVID-19.

Aging Veteran Surgical Wellness Program (GRECC Advanced Research Fellow)

January 2020

• OVET feedback: Engage caregivers as point person for coordinating care with surgical wellness team, including follow-up telehealth appointment after Veteran returns home, and learning/managing associated technological aspects. Validated need to include a pharmacist on surgical wellness team. Encouraged scheduling telehealth check within 2 days of returning home (rather than the 3 days proposed).

• Response: Refined and implemented program with eight patients before elective surgical procedures were halted due to COVID-19. Continuity of care achieved by interprofessional team who conducts pre-operative assessment to identify vulnerabilities in this population before surgery and provides telehealth follow-up to improve surgical outcomes. Currently analyzing data to assess the impact on ED visits and rehospitalization.

• Outcome: As a result of this project, RMR VAMC was the first VA to be designated as a Level 1 Geriatric Surgery Center of Excellence.

Tele-rehabilitation Program (doctoral student)

June 2020

• OVET feedback: Help Veterans set goals and monitor progress. Meaningful goals are tied to activities that contribute to the quality of life (e.g., dancing, gardening, playing with grandchildren). Social connection/social support is really important. Create teams with a team leader who would help motivate and generate friendly competition.

• Response: Included activity tracking and providing feedback to Veterans regarding progress. Included caregivers to enhance social support and safety. Based on OVET suggestions, will develop training to help caregivers feel more confident and comfortable. Still exploring ways to promote social connections effectively in virtual group exercise sessions; program participant feedback has validated the importance of OVET suggestions in this regard.

• Outcome: VA Office of Connected Care project, “Tele-rehabilitation for Medically Complex Veterans During the COVID-19 Pandemic” funded October 2020 ($169,130)

Emergency Department Weight Management and Exercise Prescription Program – Using ED visits to counsel and connect to services (Emergency Medicine physician, RMR VAMC)

October 2020

• OVET feedback: Veteran may be in pain, scared, or disoriented and unable to focus on handouts, videos, or even in-person explanations of exercise programs. Offer interactive discussion at ED discharge, after acute needs/concerns have been addressed. Physician can link exercise and weight management to relieving pain.

• Response: Refined interview guides for patients and providers to include questions re: discharge discussion, including pain management. Created succinct handout with phone numbers for follow-up questions and other VA resources for Veteran to utilize at home. Updated ED discharge instructions to include information regarding transitions of care (i.e., connections to post-ED visit services).

• Outcome: Study in progress

Effects of exercise on bone health (Advanced Research Fellow planning grant resubmission)

November 2020

• OVET feedback: Members reviewed research protocol, shared perspectives re: feasibility and burden of participation. Shared that exercise and blood draw requirements would not necessarily be a deterrent (a reviewer concern). However, number of visits and time required may be challenging. Recommended home visits for 24 and 48-hour blood draws and flexibility in scheduling.

• Response: Reviewers of original proposal expressed concerns regarding tolerance of study participants for exercise regime or required blood draws. OVET members indicated tolerance for both. Based on OVET suggestions, fellow budgeted for home visits for 24 and 48-hr blood draws and to accommodate providing health information (like cholesterol panel) to increase benefits associated with participation. OVET provided signed Letter of Support noting the importance of the proposed research to older Veterans.

• Outcome: VA Career Development Award resubmitted December 2020.