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

项目摘要/摘要 每年在重症监护病房(ICU)住院后幸存下来的老年人数量， 十年前估计为140万，随着人口老龄化，治疗方法的进步， 危重疾病，以及目前的大流行。老年ICU幸存者经常经历残疾，这是 与死亡率、制度化和家庭服务的使用增加有关。在老年人中， 社会经济上的劣势与ICU住院后一年内的更大残疾有关； 然而，无论在提供熟练的康复治疗方面的差异，一种干预可能 减轻ICU后的残疾，这一差异的基础尚不清楚。因为康复服务的交付方式不同 服务可能导致康复机会不平等，使弱势群体在残疾方面的差距长期存在 ICU幸存者，迫切需要填补这一知识空白。 这项建议的目标是评估社会经济劣势的关联，如 以收入、教育和补充保险衡量，以及康复的可能性和强度 在急性和急性后护理环境中提供服务，并评估康复强度是否 与老年ICU幸存者的下游残疾有关。我将通过以下几点来实现这一点 目的：1)评估社会经济劣势和接受治疗的可能性之间的联系 危重老年患者接受住院康复服务的数量；2)评估 社会经济劣势与接受康复服务的数量之间的关系 危重老年患者出院后90天内，包括在技工医院接受康复治疗 家庭和门诊环境中的护理和住院康复设施；以及3)评估 住院康复量与出院90天内康复量的关系 住院后一年的残疾，并确定这些联系是否受到 社会经济上的劣势。 对于这项建议，我将使用国家健康和老龄化趋势研究(NHATS)的数据， 具有全国代表性的老龄化纵向研究，具有个人层面的信息，衡量 社会经济劣势和年度功能评估，与医疗保险数据挂钩，以评估使用情况 在急症和急症后护理环境中提供康复服务。这些发现将确定脆弱的 加强康复服务和我后续工作的人口和护理环境 旨在改善老年ICU幸存者在残疾方面观察到的社会经济差异。

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.