Developing LiveWell-HF: A Palliative Rehabilitation Intervention for Older Adults with Advanced Heart Failure
Americans aged 65 years and older account for 70% of heart failure (HF)-related hospitalizations each year, and many are burdened by functional limitations and high symptom burden. In advanced HF (New York Heart Association Class III-IV) disease burden increases substantially—80% are hospitalized at least once in the last 6 months of life and many experience distress over functional decline and inability to participate in meaningful activities. Although rehabilitation improves function and quality of life in HF, to date, rehabilitation lacks a palliative care ‘lens’ to address the complex psychosocial and functional needs of older adults living with advanced HF.
Redesigning rehabilitation to incorporate principles of palliative care for older adults with advanced HF may optimize function and quality of life. As a Kornfeld Scholar, I will develop LiveWell-HF, a home-based physical therapy intervention enhanced with evidence-based, psychological palliative care strategies tailored to facilitate coping and acceptance of functional decline among older adults after advanced HF hospitalization. I will use a two-phase approach to 1) engage patients, care partners, and clinician experts to develop the preliminary LiveWell-HF intervention, and 2) test LiveWell-HF using an open pilot study design.
As a PhD-trained physical therapist and clinician-scientist in the Division of Palliative Care and Geriatric Medicine at Massachusetts General Hospital, I am uniquely positioned to conduct this research. The complementary expertise of my mentors and advisors, led by Dr. Christine Ritchie, will enable me to complete my proposed research and career development activities, which focus on training in psychosocial palliative care principles and qualitative and mixed methods research for intervention development. The NPCRC Kornfeld Scholar Program Award will provide me with the skills and data I need to compete for NIH K23 and R01 awards to further refine and test LiveWell-HF to improve the lives of older adults with advanced HF.
Tamra Keeney, PhD, DPT, is a Clinician Scientist at the Mongan Institute Center for Aging and Serious Illness and an Instructor of Medicine at Harvard Medical School. She completed her Doctorate in Physical Therapy at Saint Louis University and is a board-certified cardiovascular and pulmonary physical therapist with over 10 years of experience providing rehabilitation in academic medical centers. Dr. Keeney completed her PhD in Rehabilitation Sciences at the MGH Institute of Health Professions and an AHRQ T32 Postdoctoral Research Fellowship at the Center for Gerontology and Health Care Research at Brown University in Providence, Rhode Island. She has expertise in measurement of frailty, function, and disability and using health services research methods to evaluate relationships between these constructs, healthcare utilization and outcomes for older adults with complex chronic illness. As an early career investigator, her research is focused on developing and testing palliative rehabilitation models to optimize function and improve quality of life for older adults with advanced heart failure.