Department of Physical Therapy and Rehabilitation Science, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
Int J Environ Res Public Health. 2022 Sep 3;19(17):11021. doi: 10.3390/ijerph191711021.
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.
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.
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.
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.
当前的康复护理模式与虚弱老年人的需求不太匹配，但这对康复结果的影响尚不清楚。了解虚弱可能如何影响康复结果，以及了解一些潜在的机制，可能有助于为支付政策的改变提供信息。
这是一项对国家健康老龄化趋势研究（NHATS）第五轮数据的横断面分析。我们确定了完成一次或多次康复护理的老年人，并使用经过验证的 NHATS 弗里德虚弱量表（NHATS Fried Frailty scale）将患者分为虚弱（3/5 或更多）或非虚弱（≤2/5）。然后，我们评估了虚弱状态与三个关键患者结果之间的关联：（1）康复目标的实现，（2）康复期间的功能改善，（3）用尽保险福利后停止治疗。最后，我们使用多变量、调查加权逻辑回归模型来估计虚弱与康复结果之间的调整关系。
在美国，估计有 560 万调查加权的老年人（95%CI 510 万至 600 万）在过去一年中完成了一次康复治疗，估计有 1271290 名（95%CI 921758 至 1620822；加权：22.8%）为虚弱。虚弱的康复接受者通常年龄较大，合并症负担较重，痴呆症的患病率较高。在调整后的模型中，虚弱与较差的功能结果相关，达到康复目标的可能性较低，并且用尽康复保险福利的可能性较高。
运动是虚弱管理的一种支持良好的干预措施，但我们的结果表明，虚弱的老年人没有获得最大限度改善结果所需的康复治疗量或强度-部分原因是美国对康复服务的支付覆盖有限。
