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

项目总结/摘要 每年在重症监护室（ICU）住院的老年人人数， 据估计，十年前有140万人，随着人口老龄化， 严重的疾病和目前的流行病。老年ICU幸存者经常经历残疾， 与死亡率增加、机构化和家庭服务的使用有关。在老年人中， 在ICU住院后的一年中，社会经济劣势与更大的残疾相关; 然而，是否在提供熟练的康复治疗，一个干预，可以潜在的差异， 减轻ICU后残疾，这种差异的基础尚不清楚。因为康复服务的不同 服务可能导致康复机会不平等，使弱势群体之间的残疾差异长期存在， ICU幸存者迫切需要填补这一知识空白。 该提案的目的是评估社会经济不利因素的关联， 以收入、教育和补充保险衡量，以及康复的可能性和强度 急性和急性后护理环境中的服务，并评估康复强度是否 与老年ICU幸存者的下游残疾相关。我将通过以下方式实现这一目标 目的：1）评估社会经济劣势与接收可能性之间的关联， 老年危重患者接受的住院康复服务量; 2）评估 社会经济劣势与接受康复服务数量之间的关系 危重老年患者在出院后90天内，包括在熟练的 护理和住院康复设施，在家里，并在门诊设置;和3）评估 住院期间和出院后90天内接受的康复治疗量与 残疾在住院后的一年，并确定这些协会是否是缓和 社会经济劣势。 对于这个建议，我将使用来自国家健康和老龄化趋势研究（NHATS）的数据， 全国代表性的老龄化纵向研究，个人层面的信息，措施， 社会经济劣势和年度功能评估，与医疗保险数据相关联，以评估使用 急性和急性后护理环境中的康复服务。这些发现将确定脆弱的 人口和护理环境，加强康复服务和我的后续工作可以 旨在改善老年ICU幸存者中观察到的残疾社会经济差异。

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.