Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, California, USA.
Department of Medicine, Division of Geriatrics, University of California, San Francisco, California, USA.
Phys Ther. 2024 Jan 1;104(1). doi: 10.1093/ptj/pzad115.
The objective of this study was to estimate the prevalence of cognitive impairment (including cognitive impairment no dementia [CIND] and dementia) among Medicare fee-for-service beneficiaries who used outpatient physical therapy and to estimate the prevalence of cognitive impairment by measures that are relevant to rehabilitation practice.
This cross-sectional analysis included 730 Medicare fee-for-service beneficiaries in the 2016 wave of the Health and Retirement Study with claims for outpatient physical therapy. Cognitive status, our primary variable of interest, was categorized as normal, CIND, or dementia using a validated approach, and population prevalence of cognitive impairment (CIND and dementia) was estimated by sociodemographic variables and Charlson comorbidity index score. Age-, gender- (man/woman), race-/ethnicity-adjusted population prevalence of CIND and dementia were also calculated for walking difficulty severity, presence of significant pain, self-reported fall history, moderate-vigorous physical activity (MVPA) ≤1×/week, and sleep disturbance frequency using multinomial logistic regression.
Among Medicare beneficiaries with outpatient physical therapist claims, the prevalence of any cognitive impairment was 20.3% (CIND:15.2%, dementia:5.1%). Cognitive impairment was more prevalent among those who were older, Black, had lower education attainment, or higher Charlson comorbidity index scores. The adjusted population prevalence of cognitive impairment among those who reported difficulty walking across the room was 29.8%, difficulty walking 1 block was 25.9%, difficulty walking several blocks was 20.8%, and no difficulty walking was 16.3%. Additionally, prevalence of cognitive impairment among those with MVPA ≤1×/week was 27.1% and MVPA >1×/week was 14.1%. Cognitive impairment prevalence did not vary by significant pain, self-reported fall history, or sleep disturbance.
One in 5 older adults who use outpatient physical therapist services have cognitive impairment. Furthermore, cognitive impairment is more common in older physical therapist patients who report worse physical function and less physical activity.
Physical therapists should consider cognitive screening for vulnerable older adults to inform tailoring of clinical practice toward a patient's ability to remember and process rehabilitation recommendations.
本研究旨在估计使用门诊物理治疗的医疗保险福利接受者中认知障碍（包括认知障碍但无痴呆[CIND]和痴呆）的患病率，并通过与康复实践相关的措施来估计认知障碍的患病率。
本横断面分析纳入了 2016 年健康与退休研究中使用门诊物理治疗的 730 名医疗保险福利接受者。使用经过验证的方法，将认知状态（我们主要关注的变量）分为正常、CIND 或痴呆，并根据社会人口统计学变量和 Charlson 合并症指数评分估计认知障碍（CIND 和痴呆）的人群患病率。还使用多项逻辑回归计算了步行困难严重程度、存在显著疼痛、自我报告跌倒史、每周适度剧烈体力活动（MVPA）≤1 次和睡眠障碍频率的年龄、性别（男/女）、种族/族裔调整的 CIND 和痴呆的人群患病率。
在有门诊物理治疗师治疗的医疗保险受益人中，任何认知障碍的患病率为 20.3%（CIND：15.2%，痴呆：5.1%）。认知障碍在年龄较大、黑人、受教育程度较低或 Charlson 合并症指数评分较高的人群中更为常见。报告在房间内行走困难的人群中认知障碍的调整后人群患病率为 29.8%，在行走 1 个街区困难的人群中为 25.9%，在行走几个街区困难的人群中为 20.8%，而无行走困难的人群中为 16.3%。此外，每周 MVPA≤1 次的人群中认知障碍的患病率为 27.1%，每周 MVPA>1 次的人群中认知障碍的患病率为 14.1%。认知障碍的患病率不受显著疼痛、自我报告跌倒史或睡眠障碍的影响。
每 5 个使用门诊物理治疗师服务的老年人中就有 1 个患有认知障碍。此外，报告身体功能更差和体力活动较少的老年物理治疗患者认知障碍更为常见。
物理治疗师应考虑对易受伤害的老年人进行认知筛查，以便根据患者记忆和处理康复建议的能力来调整临床实践。
