Socioeconomic Disadvantage and Disability Following Critical Illness Among Older Persons: The Role of Rehabilitation

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PROJECT SUMMARY / ABSTRACT The number of older adults who survive a hospitalization with a stay in the intensive care unit (ICU) every year, estimated at 1.4 million a decade ago, is increasing with the aging population, advances in treatments for critical illness, and the current pandemic. Older ICU survivors frequently experience disability, which is associated with increased mortality, institutionalization, and use of home services. Among older adults, socioeconomic disadvantage is associated with greater disability in the year following an ICU hospitalization; however, whether differences in delivery of skilled rehabilitation therapy, an intervention that can potentially mitigate post-ICU disability, underlie this disparity is not known. Because differences in delivery of rehabilitation services may lead to unequal opportunities for recovery, perpetuating disparities in disability among vulnerable ICU survivors, there is an urgent need to fill this gap in knowledge. The objective of this proposal is to evaluate the association of socioeconomic disadvantage, as measured by income, education, and supplemental insurance, with the likelihood and intensity of rehabilitation services across acute and post-acute care settings, and to evaluate whether rehabilitation intensity is associated with downstream disability among older ICU survivors. I will accomplish this through the following aims: 1) To evaluate the association between socioeconomic disadvantage and the likelihood of receipt and amount of in-hospital rehabilitation services received by critically ill older patients; 2) To evaluate the association between socioeconomic disadvantage and the amount of rehabilitation services received by critically ill older patients in the 90 days following hospital discharge, including rehabilitation received at skilled nursing and inpatient rehabilitation facilities, at home, and in outpatient settings; and 3) To evaluate the associations between amount of rehabilitation received in-hospital and within 90 days of discharge with disability in the year following hospitalization, and determine whether these associations are moderated by socioeconomic disadvantage. For this proposal, I will use data from the National Health and Aging Trends Study (NHATS), a nationally representative longitudinal study of aging, with individual-level information on measures of socioeconomic disadvantage and annual assessments of function, linked with Medicare data to assess the use of rehabilitation services across acute and post-acute care settings. These findings will identify vulnerable populations and care settings where enhanced rehabilitation services and my subsequent work can be targeted to improve observed socioeconomic disparities in disability among older ICU survivors.