The Gerofit Program: Digital Innovations for “Gerofit at ...15. Acknowledgements • VHA GRECCs, Durham VA GRECC, Durham VA Healthcare System, and national Geriatrics and Extended

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The Gerofit Program: Digital Innovations for “Gerofit at Home””

Miriam C. Morey, Ph.D.Professor of Medicine, Duke UniversityCo-Director, Duke Claude D. Pepper Older

Americans Independence CenterGRECC/ Associate Director of Research DurhamVA Healthcare System, Durham, NC

Dissemination Supported by:Office of Geriatrics and Extended CareT-21 Patient Centered Alternatives to Institutional Extended Care (NILTC)and VA Office of Rural Health

Gerofit Program Overview • Gerofit is a group-based supervised exercise and health

promotion program for older adults. Established in the Durham VA in 1986.

• Declared a VHA Best Practice. Now undergoing national dissemination – 14 new sites added in last 5 years (~$12 M), over 7000 Veterans reached.

• Exercises are offered 3 days per week and are individually tailored to functional impairments and patient directed goals, with no time limit on duration of participation.

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Gerofit Enterprise-Wide Initiative

National Expansion Funded by Geriatrics and Extended Care Mentored Partnership Programand Office of Rural Health Enterprise- Wide Initiative

Honolulu

Los Angeles DURHAMLittle

Rock

Canandaigua / Rochester

Salem Baltimore

Miami

PittsburghCincinnati

Michigan

Denver

VISN 21

VISN 6

VISN 8

VISN 16

VISN 19

VISN 22

VISN 10

VISN 4

VISN 5

VISN 10

VISN 6

VISN 2

Puget SoundVISN 20

Boston

Nashville

Who we areThe Gerofit Exercise and Health Promotion Program

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https://www.youtube.com/watch?v=msFsjkw3-Ag&list=PLtqdPNujKaCntJ03vT6EcVIsS3k9E5Zxk

Replication of Results

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Morey, et al. Should Structured Exercise be Promoted as A Model of Care? Dissemination of the VA Gerofit Program. J Am Ger Soc 2:2018

The Million Dollar Challenge

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Can we deliver Gerofit to individuals not able to attend facility-based programs?

• How do we do it?

• Can we engage?

• It is effective?

Gerofit Outreach Innovations

• Tele-Gerofit – Exercise programs using clinical telehealth to deliver group-based exercise to Veterans at Community-Based Outpatient Clinics

• Gerofit at Home – We are piloting Gerofit-to-the-Home using Video conference call technology (VA Video Connect) that allows Veterans to participate in interactive group based classes with a live exercise physiologist using their own smart device or laptop.

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Tele-Gerofit

Video Tele-health from

Conference Room to

Exercise Class

Kris Ann Oursler, MD, Salem VAMC

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Pros and Cons of Tele-GerofitPros

• Initial outcomes indicate significant improvement on functional outcomes

• Participant engagement is favorable

Cons • Rooms may be small and limit class size to 5-6

Veterans at a time.• CVT scheduling issues

o Competition with other time blocks for other CVT programs

o TCTs are needed during exercise class for safety monitoring

Gerofit at Home

Video Telehealth from

the Conference Room to

the Home

Piloted by Durham VA

Stephen Jennings, M.A.

Video on Demand: Exercise leader in conference room with 5 participating Veterans

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Functional Assessment

Becoming part of a group

Procedures

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• Veterans don’t need anything but an email if using PC/Amazon/Android devices, those using iOS (apple) will need to do a onetime install of an app called VA Video Connect.

• Entire process takes <2 minutes once initial first time set up has been completed

• Essentially Veteran receives an email with a hyperlink and they are then shown a virtual connection

• Provider will need their location and emergency contact. Provider has Veteran crisis line and specific number to dial in case of emergency that can pinpoint 9-1-1 in their town to their location.

Pros and Cons of Tele-GerofitPros

• Ability to reach people almost anywhere in the country

Cons • Limited volume

Patient Perspective – From Miami

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Acknowledgements• VHA GRECCs, Durham VA GRECC, Durham VA Healthcare System, and national Geriatrics and Extended Care

programs• GEC Mentored Partnership Program• VHA Office of Rural Health• Partner Programs

– Ann Arbor (GRECC) (Alexander, Althuis, Nabozny)– Baltimore (GRECC) (Katzel, Giffuni, Steinbrenner, Melvin, Lyons)– Canandaigua/Rochester (Kopp, Cammarata, Biddle, Reynolds)– Cincinnati ( Holder, Versteeg, Patel, Kindler)– Eastern Colorado Healthcare System (GRECC) (Kohrt, Abbate, Bauers, Wherry, Wellington)– Greater Los Angeles (GRECC) (Castle, Lee, Blanchard,)– Honolulu (GREC) (McDonald, Miyamoto, Kaai, Harrington)– Little Rock (GRECC) (Kalpana, Evans, Smith, Taylor)– Miami (GRECC) (Valencia, Condill, Coleman, Henriquez)– Pittsburg (GRECC) (Allsup, Smith, Kellar, Foreman)– Puget Sound (GEC/GRECC) (Tayade, Wesley, Colglazier, Froehlich)– Salem (Oursler, Jain, Briggs, Angiletta, Duff)– Tennessee Valley Healthcare System (GRECC) (Murff, Salloum, Noel, Cook, Graham, Page)– New England Healthcare System (GRECC) (Bean, Driver, Ayvazian, Harris, Wortham)

Durham (GRECC) (Morey, Pearson, Manning, Applewhite, Jennings, Bettger, Sloane, Pepin, GRECC, Institute for Medical Research)Duke Claude D. Pepper Older Americans Independence Center and Center for the Study of Aging and Human DevelopmentGeriatrics and Extended Care Data Analysis Center (Intrator, Westgate, Li, Veazie)

• Please visit our website at Gerofit: http://www.va.gov/geriatrics/gerofit/gerofit_Home.asp• Documentaries are listed under Success Stories tab.

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