Factors Associated with Duration of Rehabilitation Among Older Adults with Prolonged Hospitalization
- 22 December 2020
- journal article
- research article
- Published by Wiley in Journal of the American Geriatrics Society
- Vol. 69 (4), 1035-1044
- https://doi.org/10.1111/jgs.16988
Abstract
BACKGROUND/OBJECTIVES Older adults are prone to functional decline during prolonged hospitalization. Although rehabilitation therapy is critical to preserving function, little is known about rehabilitation duration (RD) in this population. We sought to determine the extent of rehabilitation therapy provided to older adults during prolonged hospitalization, and whether this differs by sociodemographic and clinical characteristics. DESIGN Retrospective cohort. SETTING Single‐site safety‐net hospital. PARTICIPANTS Older adults (≥65 years) hospitalized for ≥14 days between 2016 and 2017. MEASUREMENTS The primary outcome was RD, defined as the average number of minutes of physical and occupational therapy per week. We used a multivariable generalized linear model to assess for differences in RD by sociodemographic and clinical characteristics. For a sub‐cohort of hospitalizations with a baseline mobility assessment, we repeated analyses including mobility limitation as a covariate. RESULTS Among 1,031 hospitalizations by 925 unique patients (median age 72, 49% female, 79% non‐white, 40% non‐English speaking), the median RD was 61.3 minutes/week (interquartile range = 16.5–127.3). Covariates associated with lesser RD included black (57.2 fewer minutes/week; 95% confidence interval (CI) = 22.9–91.4) and Hispanic (75.6 fewer minutes/week; 95% CI = 33.8–117.4) race/ethnicity, speaking a language other than English or Spanish (51.7 fewer minutes/week; 95% CI = 21.3–82.0), prolonged mechanical ventilation (30.0 fewer minutes/week; 95% CI = 6.6–53.3), and do‐not‐resuscitate code status (36.0 fewer minutes/week; 95% CI = 17.1–54.8). The inclusion of mobility limitation among the sub‐cohort (n = 350) did not meaningfully change the associations. CONCLUSION We found large disparities in RD for racial/ethnic and language minorities and clinically vulnerable older adults (mechanical ventilation and do‐not‐resuscitate code status), independent of clinical severity and functional and cognitive impairment. Greater RD for these groups may improve functional outcomes and narrow the disparity gap.Funding Information
- National Institute on Aging (K23AG052603)
This publication has 49 references indexed in Scilit:
- Effectiveness and feasibility of early physical rehabilitation programs for geriatric hospitalized patients: a systematic reviewBMC Geriatrics, 2013
- Associations Between the Use of Critical Care Procedures and Change in Functional Status at DischargeJournal of Intensive Care Medicine, 2012
- Clinical Characteristics and Outcomes of Hospitalized Older Patients with Distinct Risk Profiles for Functional Decline: A Prospective Cohort StudyPLOS ONE, 2012
- Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee ArthroplastyClinical Orthopaedics and Related Research, 2010
- Change in Disability After Hospitalization or Restricted Activity in Older PersonsJAMA, 2010
- Influence of language barriers on outcomes of hospital care for general medicine inpatientsJournal of Hospital Medicine, 2010
- Functional Decline and Recovery of Activities of Daily Living in Hospitalized, Disabled Older Women: The Women's Health and Aging Study IJournal of the American Geriatrics Society, 2009
- Recovery of Activities of Daily Living in Older Adults After Hospitalization for Acute Medical IllnessJournal of the American Geriatrics Society, 2008
- Health-Related Quality of Life in Older Adults at Risk for DisabilityAmerican Journal of Preventive Medicine, 2007
- Prevalence and Outcomes of Low Mobility in Hospitalized Older PatientsJournal of the American Geriatrics Society, 2004