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    Rehabilitation Outcomes among Frail Older Adults in the United States

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    Author
    Falvey, Jason R.
    Ye, Joanna Z.
    Parker, Elizabeth A.
    Beamer, Brock A.
    Addison, Odessa
    Date
    2022-09-03
    Journal
    International journal of environmental research and public health
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.3390/ijerph191711021
    Abstract
    BACKGROUND: Current rehabilitation care paradigms are not well aligned with the needs of frail older adults, but the resultant impact on rehabilitation outcomes is unclear. Understanding how frailty may impact rehabilitation outcomes, and understanding some of the underlying mechanisms, may help inform payment policy changes. DESIGN: This study was a cross-sectional analysis of data from Round 5 of the National Health and Aging and Trends Study (NHATS). We identified older adults who had completed one or more episodes of rehabilitation care and used a validated 5-item NHATS Fried Frailty scale to categorize patients as frail (3/5 or more) or non-frail (≤2/5). We then evaluated the association between frailty status and three key patient outcomes: (1) achievement of rehabilitation goals, (2) functional improvement during rehabilitation episodes, and (3) discontinuation of therapy after exhausting insurance benefits. Lastly, we used multivariable, survey-weighted logistic regression models to estimate adjusted relationships between frailty and rehabilitation outcomes. RESULTS: An estimated 5.6 million survey-weighted older adults in the United States (95% CI 5.1 to 6.0 million) completed an episode of rehabilitation in the past year, an estimated 1,271,290 (95% CI 921,758 to 1,620,822; weighted: 22.8%) of whom were frail. Frail rehabilitation recipients were generally older, had a greater comorbidity burden, and had a higher prevalence of dementia. In adjusted models, frailty was associated with poorer functional outcomes, a lower probability of meeting rehabilitation goals and a greater likelihood of exhausting rehabilitation insurance benefits. CONCLUSIONS: Exercise is a well-supported intervention for the management of frailty, but our results suggest that frail older adults are not getting the volume or intensity of rehabilitation treatment needed to maximally improve outcomes-in part due to limited payer coverage of rehabilitation services in the United States.
    Data Availibility
    Data from National Health and Aging Trends Study (NHATS) is sponsored by the National Institute on Aging (grant number NIA U01AG32947) and was conducted by the Johns Hopkins University
    Data / Code Location
    https://nhats.org/researcher
    Sponsors
    American Heart Association
    Keyword
    frailty
    older adults
    physical therapy
    rehabilitation
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/19813
    ae974a485f413a2113503eed53cd6c53
    10.3390/ijerph191711021
    Scopus Count
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