Katherine S McGilton1, Michael A Campitelli2, Jennifer Bethell3, Jun Guan2, Shirin Vellani4, Alexandra Krassikova5, Abeer Omar6, Colleen J Maxwell7, Susan E Bronskill8. 1. KITE - Toronto Rehabilitation Institute- University Health Network, Toronto, Ontario, Canada; Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. Electronic address: Kathy.mcgilton@uhn.ca. 2. ICES, Toronto, Ontario, Canada. 3. KITE - Toronto Rehabilitation Institute- University Health Network, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. 4. KITE - Toronto Rehabilitation Institute- University Health Network, Toronto, Ontario, Canada; Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada. 5. KITE - Toronto Rehabilitation Institute- University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. 6. Trent/Fleming School of Nursing, Trent University, Peterborough, Ontario, Canada. 7. ICES, Toronto, Ontario, Canada; Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada. 8. ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: To describe differences in home care use in the 30-days following discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared to those without dementia. DESIGN: Retrospective cohort study of individually-linked health administrative data. SETTING: Community dwelling older adults following discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS: 17,263 older adults, of whom 2,489 (14.4%) had dementia, who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The proportion receiving home care services, and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking), in the 30-days after discharge were compared by dementia status with multivariable models, stratified by sex. RESULTS: Compared to those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30-days after discharge from inpatient rehabilitation (87.0% vs. 79.0%, p<0.001), including personal/homemaking services (66.1% vs 46.4%, p<0.001), and occupational therapy (45.3% vs 37.4, p<0.001), but not physiotherapy (55.8% vs. 56.2%, p=0.677) or nursing (19.6% vs. 18.7%, p=0.268). After adjustment, older adults with dementia were more likely to receive home care within men (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.57-2.57) and women (OR 1.50; 95% CI 1.30-1.74) as well as more services (men rate ratio [RR] 1.60; 95% CI 1.44-1.79; women RR 1.50; 95% CI 1.41-1.60). CONCLUSION: Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that resources permitting, all older adults receive physiotherapy to facilitate recovery.
OBJECTIVE: To describe differences in home care use in the 30-days following discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared to those without dementia. DESIGN: Retrospective cohort study of individually-linked health administrative data. SETTING: Community dwelling older adults following discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS: 17,263 older adults, of whom 2,489 (14.4%) had dementia, who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The proportion receiving home care services, and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking), in the 30-days after discharge were compared by dementia status with multivariable models, stratified by sex. RESULTS: Compared to those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30-days after discharge from inpatient rehabilitation (87.0% vs. 79.0%, p<0.001), including personal/homemaking services (66.1% vs 46.4%, p<0.001), and occupational therapy (45.3% vs 37.4, p<0.001), but not physiotherapy (55.8% vs. 56.2%, p=0.677) or nursing (19.6% vs. 18.7%, p=0.268). After adjustment, older adults with dementia were more likely to receive home care within men (odds ratio [OR] 2.01; 95% confidence interval [CI] 1.57-2.57) and women (OR 1.50; 95% CI 1.30-1.74) as well as more services (men rate ratio [RR] 1.60; 95% CI 1.44-1.79; women RR 1.50; 95% CI 1.41-1.60). CONCLUSION: Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that resources permitting, all older adults receive physiotherapy to facilitate recovery.