Oh Sung Soo, Yoo Ji Won, Chaudhry Stefan, Jeong Connor, Bae Deanna, Mohanadasan Sumegha, Frimer Leora, Kim Yonsu, Shen Jay J
Department of Occupational and Environmental Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea.
Department of Internal Medicine, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, United States.
Front Public Health. 2024 Dec 2;12:1322830. doi: 10.3389/fpubh.2024.1322830. eCollection 2024.
Falls and extremity fractures often occur in people living with Alzheimer's disease and related disorders (ADRD). In post-fracture care, these patients are cared for either at rehabilitation facilities or their homes. The coronavirus disease 2019 (COVID-19) pandemic limited the utilization of rehabilitation facilities. In areas with provider shortages, this trend poses a risk of disability and caregiver burdens, particularly in racial minorities who under-utilize rehabilitation facilities.
To assess racial disparities in post-acute care (PAC) at rehabilitation facilities among people living with ADRD and extremity fractures during the COVID-19 pandemic.
We summarized the PAC locations by (1) rehabilitation facilities (skilled nursing facilities and inpatient rehabilitation facilities) and (2) homes (homes with self-care and homes with services) for each study year. We observed the yearly percentage trends in PAC at rehabilitation facilities over the total post-acute discharge period. We assessed demographics (age, sex, and race), clinical comorbidities (fracture sites), utilization factors (pay source and hospital location), and COVID-19 pandemic status (pre-/post-pandemic years). We used multivariate logistic regression to estimate the association between these factors and PAC in the rehabilitation facilities.
The proportion of individuals receiving PAC declined in rehabilitation facilities, whereas the proportion of individuals receiving PAC at home with services continuously increased. Being Hispanic, presence of cerebrovascular disorder (CVD), use of Medicaid services, and the COVID-19 pandemic were associated with lower probabilities of utilizing rehabilitation facilities.
Among the individuals with ADRD and extremity fractures, the proportion of those who underutilized rehabilitation facilities was higher in Hispanics compared with other races. Caregiving for Hispanics, presence of CVD, and use of Medicaid services were associated with the risk of disability and caregiver burden, due to shifting trends from rehabilitation facilities to homes with services. Geriatric workforce education should be prioritized to enhance the competencies of healthcare providers serving these individuals to relieve caregiver burdens in areas with provider shortage.
跌倒和四肢骨折在患有阿尔茨海默病及相关疾病（ADRD）的人群中经常发生。在骨折后护理中，这些患者要么在康复机构接受护理，要么在家中接受护理。2019冠状病毒病（COVID-19）大流行限制了康复机构的使用。在医疗服务提供者短缺的地区，这种趋势带来了残疾风险和护理负担，尤其是在康复机构利用率较低的少数族裔中。
评估COVID-19大流行期间ADRD患者和四肢骨折患者在康复机构接受急性后期护理（PAC）方面的种族差异。
我们按以下两类总结了每个研究年度的PAC地点：（1）康复机构（专业护理机构和住院康复机构）；（2）家庭（自理家庭和有服务的家庭）。我们观察了康复机构在整个急性后期出院期间PAC的年度百分比趋势。我们评估了人口统计学特征（年龄、性别和种族）、临床合并症（骨折部位）、利用因素（支付来源和医院位置）以及COVID-19大流行状况（大流行前/后年份）。我们使用多变量逻辑回归来估计这些因素与康复机构PAC之间的关联。
在康复机构接受PAC的个体比例下降，而在家中接受有服务的PAC的个体比例持续上升。西班牙裔、存在脑血管疾病（CVD）、使用医疗补助服务以及COVID-19大流行与使用康复机构的可能性较低相关。
在患有ADRD和四肢骨折的个体中，西班牙裔未充分利用康复机构的比例高于其他种族。由于从康复机构向有服务的家庭的趋势转变，对西班牙裔的护理、CVD的存在以及医疗补助服务的使用与残疾风险和护理负担相关。应优先开展老年劳动力教育，以提高为这些个体提供服务的医疗保健提供者的能力，从而减轻医疗服务提供者短缺地区的护理负担。
