Marie Butera sits down in a straight chair in the middle of her living room and holds a long red strip of elastic material stretched between her hands. She pulls her arms away from each other, then relaxes; pulls again, then relaxes. The two women sitting on the couch instruct her to place her foot on the exercise band. She pushes her foot away from her, struggling against the resistance of the elastic, then relaxes. She pushes again, knowing that every movement makes her stronger. Butera, 73, is not an avid senior who likes to work out but one of the first to participate in a new clinical trial at the University of Texas Medical Branch at Galveston.
Using different combinations of in-home exercise and protein shakes or testosterone therapy, this program was designed to study how to help elderly patients who have been hospitalized get better and stronger upon their return home.
The elderly are more prone to being adversely affected by a stay in the hospital than younger patients. Whereas young patients tend to keep getting better after being released, the same is not true for most older patients. Being confined to a hospital bed can lead to a cascading onset of problems due to weakness. Lack of appetite — a typical issue for hospitalized elders — just adds to the patient’s loss of strength, mobility and ability to perform daily tasks upon returning home. Loss of physical functions can result in secondary illness, injury and rehospitalization.
With the implementation of the Affordable Care Act in October 2012, hospitals are now penalized by Medicare and Medicaid if they have too large a percentage of hospital readmissions within 30 days after initial discharge.
“We are trying to break the cycle of rehospitalization,” said Rachel Deer, the post-doctoral fellow running the clinical trial. “By using different intervention strategies we can help the elderly population recover from their hospital stay more quickly.”
Dr. Elena Volpi, senior investigator of the study, directs UTMB’s Sealy Center on Aging. She says the goal of the trial is to help seniors recover their physical function after a serious illness and maintain their independence.
In March, Butera was admitted to John Sealy Hospital for gastrointestinal bleeding. Over her four-day stay, her gut improved, but her muscles began to atrophy. When she was released home, she was very weak and could only get around with a four-wheeled walker.
Patients who are released from UTMB’s Acute Care for Elders Unit at John Sealy Hospital are offered an opportunity to participate in the study. Participants are assigned to follow one of the therapies and are monitored for 30 days.
Butera randomly was selected to be in a group and her physical functions were assessed before she left the hospital. Her at-home regimen combined exercise and nutrition. Her job was to drink a supplement shake twice a day and exercise three times a week. She was reassessed at the end of the month-long trial and the researchers found she had improved dramatically. She has not returned to the hospital.
Preliminary findings indicate that most patients taking part in the study have had very positive results, said Deer.
Butera stuck to her schedule, drank her shake twice a day and exercised three times a week. She healed quickly. She became much stronger. By the end of 30 days, she had not only ditched the walker, but was strolling around her neighborhood without assistance.
“This study has given me the ability to walk again, to be independent again,” she says as she hugs and kisses the two women visiting in her home. Deer, along with project coordinator Shawn Goodlett, visited Butera twice a week for the month she participated in the study.
“Without them, I am not like this,” she says as she strides proudly around her living room.