Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Division of Geriatrics and Palliative Medicine, Providence, RI, USA.
Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA.
J Am Med Dir Assoc. 2024 Dec;25(12):105286. doi: 10.1016/j.jamda.2024.105286. Epub 2024 Sep 25.
Skilled therapies (STs), including audiology, speech-language therapy, occupational therapy, and physical therapy, can address functional deficits in dementia. This study aims to quantify the association between ST and successful discharge after heart failure (HF) hospitalization in persons living with dementia.
Retrospective cohort study.
We included veterans with dementia (VwD) hospitalized for HF in Veterans Affairs (VA) medical centers and then admitted to non-VA skilled nursing facilities (SNFs) from January 2011 to June 2019.
Follow-up continued 120 days after SNF admission. We measured ST hours per week using MDS admission assessments. We defined successful discharge as SNF discharge occurring within 90 days of SNF admission with MDS discharge status not hospital or institutional setting, and 30 days' survival after discharge without Medicare or VA-paid rehospitalization or reinstitutionalization. We estimated relative risk using multiple variable regression to adjust for measured sources of confounding.
Our final sample included 8255 VwD. The mean (SD) age was 80 (10) years, and 8074 (98%) were male. Successful discharge occurred in 2776 (34%) of the sample. The median (IQR) weekly hours of ST was 10.4 (7.1-12.1). Sextile 1 received less than 5.2 hours per week of ST. The adjusted relative risk (95% CI) for sextiles 2-6 compared with sextile 1 were, respectively, 2.20 (1.85-2.62), 2.48 (2.09-2.94), 2.52 (2.12-2.99), 2.62 (2.21-3.11), and 2.69 (2.27-3.19).
During SNF care after HF hospitalization, 5.3 or more hours of STs per week was associated with a higher rate of successful discharge, in a roughly dose-dependent fashion, up to a 170% increase in the highest sextile of ST hours.
Higher ST hours are associated with successful discharge from SNF after HF hospitalization.
听力、言语、职业和物理疗法等专业治疗（ST）可以解决痴呆症患者的功能缺陷。本研究旨在定量评估 ST 与痴呆症患者心力衰竭（HF）住院后成功出院之间的关系。
回顾性队列研究。
我们纳入了在退伍军人事务部（VA）医疗中心因 HF 住院、随后在 2011 年 1 月至 2019 年 6 月期间入住非 VA 熟练护理设施（SNF）的痴呆症退伍军人（VwD）。
在 SNF 入院后 120 天继续随访。我们使用 MDS 入院评估测量每周 ST 小时数。我们将成功出院定义为 SNF 出院发生在 SNF 入院后 90 天内，MDS 出院状态为非医院或机构设置，出院后 30 天内无 Medicare 或 VA 支付的再次住院或再次入院。我们使用多变量回归估计相对风险，以调整测量的混杂来源。
我们的最终样本包括 8255 名 VwD。平均（SD）年龄为 80（10）岁，8074 名（98%）为男性。样本中有 2776 名（34%）成功出院。每周 ST 中位（IQR）小时数为 10.4（7.1-12.1）。第 1 sextile 接受的每周 ST 时间少于 5.2 小时。与第 1 sextile 相比，第 2-6 sextile 的调整后的相对风险（95%CI）分别为 2.20（1.85-2.62）、2.48（2.09-2.94）、2.52（2.12-2.99）、2.62（2.21-3.11）和 2.69（2.27-3.19）。
在 HF 住院后 SNF 护理期间，每周接受 5.3 小时或更多 ST 治疗与更高的成功出院率相关，呈大致剂量依赖性，最高 sextile 的 ST 小时增加了 170%。
更高的 ST 小时与 HF 住院后从 SNF 成功出院相关。
