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Implementing Exercise Programs For Frail Older Adults In Skilled Nursing Facilities: Clinical Reasoning And Practice Patterns Of Physical And Occupational Therapists.
Bloch, Thomas A.
Bloch, Thomas A.
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As the global population ages, Skilled Nursing Facilities (SNFs) are increasingly populated by frail older adults with complex rehabilitation needs. Despite growing evidence supporting the role of exercise in reversing or mitigating frailty, implementation in SNF settings remains inconsistent and underexplored. This dissertation examines how exercise-based rehabilitation is delivered to frail residents in SNFs, with a particular focus on the clinical reasoning processes of physical and occupational therapists (PTs/OTs). Drawing on a three-phase design, the research includes: (1) a scoping review of international literature on exercise programs for frailty in institutional settings, (2) a quantitative analysis of exercise program implementation across Vermont SNFs, and (3) a Delphi study capturing expert PTs/OTs perspectives on clinical decision-making in frailty care. Findings reveal considerable variability in program structures, highlight barriers such as institutional constraints and lack of standardized protocols, and underscore the nuanced reasoning required to adapt interventions for frail, cognitively impaired, or medically complex residents. The study integrates the FRAIL-NH scale as both a practical tool and conceptual framework, and is grounded in the Clinical Reasoning in Context (CRC) model. Together, the findings illuminate key pathways toward more responsive, evidence-informed, and contextually feasible rehabilitation models. The results offer implications for clinical practice, therapist education, policy development, and the design of person-centered care models that align with the realities of aging populations in long-term care.
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2026
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Bloch_uvm_0243D_11958.pdf
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