Skilled Nursing Facility Rehabilitation Intensity and Successful Discharge in Persons with Dementia.

Autor:	Bayer TA; 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. Electronic address: Thomas_bayer@brown.edu., Jiang L; Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA., Singh M; 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; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA., Kunicki ZJ; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA., Browne JW; Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA., Nubong T; Providence VA Medical Center, Providence, RI, USA., Kelso CM; Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Seattle, WA, USA., McGeary JE; Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA., Wu WC; Providence VA Medical Center, Long-Term Services and Supports Center of Innovation, Providence, RI, USA; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA; Providence VA Medical Center, Providence, RI, USA., Rudolph JL; 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; Brown School of Public Health, Department of Health Services Policy, and Practice, Providence, RI, USA.
Jazyk:	angličtina
Zdroj:	Journal of the American Medical Directors Association [J Am Med Dir Assoc] 2024 Dec; Vol. 25 (12), pp. 105286. Date of Electronic Publication: 2024 Sep 25.
DOI:	10.1016/j.jamda.2024.105286
Abstrakt:	Objectives: 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. Design: Retrospective cohort study. Setting and Participants: 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. Methods: 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. Results: 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). Discussion: 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. Conclusions and Implications: Higher ST hours are associated with successful discharge from SNF after HF hospitalization. Competing Interests: Disclosures The authors declare no conflicts of interest. (Published by Elsevier Inc.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu