Category: Neighborhood and Built Environment

13 - VHA Geriatric Physical Therapy Residencies: Expanding Preventative Care for Aging Veterans

Americans are aging with projections that one in four US residents will be 65 and older by 2060.  The National Center for Veterans Analysis and Statistics of the US Department of Veterans Affairs indicated in 2016 that 48% of the 20 million Veterans in the United States were older adults.  Healthcare workers of the future will need to demonstrate competency in the management of a growing geriatric medically complex population.  To meet this mounting need, in 2013, Cincinnati VA Medical Center & University of Cincinnati Residency in Geriatric Physical Therapy became the first accredited physical therapy residency in geriatrics in the Veterans Health Administration (VHA).

At the heart of this residency is the recognition that collaborative models of care addressing the unique needs of aging Veterans can foster aging in place and reduce a spiraling healthcare burden for this age group.  One in three older Americans fall each year and, for adults >65 years, falls remain the leading cause of fatal and nonfatal injuries.  The sixth leading cause of death for the elderly is Alzheimer's Disease.  Costs associated with Alzheimer's Disease are expected to surpass $1.1 trillion by 2050 as the current number of Americans with this disease (5.3 million in 2015) is expected to triple. Another chronic disorder that affects many Americans (50% more men than women) is Parkinson’s Disease, with an average age of onset of 60.  Each year approximately 60,000 Americans are diagnosed with Parkinson Disease and the risk increases with age.

In four short years, our residents have helped to develop:  a collaborative Movement Disorders Clinic working in partnership with Neurology and Speech to prescreen Veterans with Parkinson’s and other movement disorders for preventative interventions; Geriatric Evaluation Clinic working to assist disabled and frail older persons at risk for further decline and institutional placement by optimizing their health, function, and ability to live with the greatest degree of independence; Preventing Amputations in Veterans Everywhere (PAVE) collaboration with Podiatry and Prosthetics/Orthotics Services to reduce major amputations and sequelae from minor surgeries while also prescreening for a Peripheral Arterial Disease (PAD) exercise/wellness program; and the establishment of Gerofit, a free prescribed group exercise class for Veterans age 65 and older.  Since 2013, we have been joined by three additional geriatric residencies and our next step is to look for ways we can collectively advocate for aging Veterans across our national healthcare system.


Alice D. Holder

Rehabilitation Coordinator/PT Residency Program Director
Cincinnati VA Medical Center
Cincinnati, Ohio

Dr. Holder has served a largely geriatric patient population at the Cincinnati VA Medical Center for more than 22 years. As a Board Certified Clinical Specialist in Geriatric Physical Therapy she has helped to develop 2 Physical Therapy Residencies and 1 OT Fellowship. In 2017, she helped to secure a 2-year grant to develop Gerofit, a wellness program for older Veterans, at her local facility in partnership with the Durham VA/Geriatric Research Education and Clinical Center (GRECC). A 1995 graduate of The Ohio State University, she obtained her doctorate from the University of Indianapolis in 2009 and her board specialization in 2013. Additional competencies include wheelchair seating & mobility and adaptive sports.

Madeline L. Versteeg

physical therapist
Cincinnati VA Medical Center
Cincinnati, Ohio

Ms Versteeg is a physical therapist, board certified as a geriatric clinical specialist, with 20+ years of experience working with older adults. She is employed at the Cincinnati VA Medical Center where she provides physical therapy services for Veterans, serves as a mentor for PT geriatric residents and PT students, and acts as a facilitator for the Gerofit wellness exercise program. She is a Certified Exercise Expert for Aging Adults (CEEAA). Additionally, she is a Master Trainer for the Matter of Balance fall prevention program.