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Rehabilitation Outcomes among Frail Older Adults in the United States

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 inf...

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Autores principales: Falvey, Jason R., Ye, Joanna Z., Parker, Elizabeth A., Beamer, Brock A., Addison, Odessa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517853/
https://www.ncbi.nlm.nih.gov/pubmed/36078737
http://dx.doi.org/10.3390/ijerph191711021
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author Falvey, Jason R.
Ye, Joanna Z.
Parker, Elizabeth A.
Beamer, Brock A.
Addison, Odessa
author_facet Falvey, Jason R.
Ye, Joanna Z.
Parker, Elizabeth A.
Beamer, Brock A.
Addison, Odessa
author_sort Falvey, Jason R.
collection PubMed
description 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.
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spelling pubmed-95178532022-09-29 Rehabilitation Outcomes among Frail Older Adults in the United States Falvey, Jason R. Ye, Joanna Z. Parker, Elizabeth A. Beamer, Brock A. Addison, Odessa Int J Environ Res Public Health Brief Report 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. MDPI 2022-09-03 /pmc/articles/PMC9517853/ /pubmed/36078737 http://dx.doi.org/10.3390/ijerph191711021 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Falvey, Jason R.
Ye, Joanna Z.
Parker, Elizabeth A.
Beamer, Brock A.
Addison, Odessa
Rehabilitation Outcomes among Frail Older Adults in the United States
title Rehabilitation Outcomes among Frail Older Adults in the United States
title_full Rehabilitation Outcomes among Frail Older Adults in the United States
title_fullStr Rehabilitation Outcomes among Frail Older Adults in the United States
title_full_unstemmed Rehabilitation Outcomes among Frail Older Adults in the United States
title_short Rehabilitation Outcomes among Frail Older Adults in the United States
title_sort rehabilitation outcomes among frail older adults in the united states
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9517853/
https://www.ncbi.nlm.nih.gov/pubmed/36078737
http://dx.doi.org/10.3390/ijerph191711021
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