Rehabilitation Services Use and Patient-Reported Outcomes Among Older Adults in the United States

Abstract

Objective: To characterize rehabilitation service use among community-dwelling older adults in the United States by identifying predictors of rehabilitation utilization, patient-reported functional improvement, and rehabilitation goal attainment.

Design: Cross-sectional analysis of the 2015 National Health and Aging Trends Study, which used an age-stratified, multistage sampling design and oversampled blacks and the oldest old (≥85y).

Setting: Standardized, in-person home interviews and physical performance testing.

Participants: Nationally representative sample of community-dwelling Medicare beneficiaries (N=7487) aged ≥65 years.

Interventions: Not applicable.

Main outcome measures: Rehabilitation services use (physical therapy, occupational therapy, and speech therapy) across all settings in the last year, patient-reported functional improvement, and patient-reported rehabilitation goal attainment.

Results: Twenty percent of older adults reported rehabilitation use in the last year. In a multivariable model, rehabilitation use was significantly lower among blacks and higher among those with higher education, chronic medical conditions, pain, history of falls, and severe limitations in physical performance. Overall, 72% reported functional improvement during rehabilitation, and 75% reported meeting their goals by discharge. Improved function was associated with longer duration of rehabilitation. A significantly lower percentage of older adults with bothersome pain and severe physical limitations reported meeting rehabilitation goals.

Conclusions: Most older adults who received rehabilitation reported functional improvement and meeting rehabilitation goals. However, social disparities were evident with lower rehabilitation utilization among blacks and those with less education. Importantly, functional improvement and goal attainment did not vary by demographics or diagnoses. Longer duration of rehabilitation and improved pain management may be necessary for functional improvement and goal attainment.

Keywords: Health services for the aged; Patient reported outcome measures; Recovery of function; Rehabilitation.