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Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States

Published:April 03, 2017DOI:https://doi.org/10.1016/j.apmr.2017.02.027

      Abstract

      Objective

      To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment.

      Design

      Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y).

      Setting

      Standardized, in-person home interviews and physical performance testing.

      Participants

      Nationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years.

      Interventions

      Not applicable.

      Main Outcome Measures

      Rehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment.

      Results

      Twenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals.

      Conclusions

      Most older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), CI (confidence interval), NHATS (National Health and Aging Trends Study), SPPB (Short Physical Performance Battery)
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