A recent study confirmed the link between social determinants of health (SDOH), such as dual Medicare and Medicaid eligibility, rural residence and limited English proficiency, and reduced delivery of skilled rehabilitation services to older adults during a critical illness hospitalization.
The nationally representative cohort study analyzed data from over 1,600 hospitalizations involving intensive care unit (ICU) stays among older adults. Study data originated with the National Health and Aging Trends Study linked with Medicare claims (2011-2018). Participants included older adults hospitalized with a stay in the intensive care unit (ICU). Data were analyzed from August 2022 to September 2023.
The findings revealed that certain SDOH factors were associated with reduced access to physical therapy (PT) and occupational therapy (OT) services. Notably, older adults who were eligible for both Medicare and Medicaid had a 30% lower chance of receiving any PT or OT during their hospital stay compared to those with only Medicare coverage. Similarly, older adults residing in rural areas had a 35% lower likelihood of receiving these services compared to their urban counterparts.
Additionally, individuals with limited English proficiency received 45% less PT or OT compared to those proficient in English. The study suggested that factors such as hospital resources, staffing levels and the adoption of evidence-based strategies for promoting rehabilitation may contribute to these disparities.
Overall, 68.5% of the older adults in the study received some form of PT or OT during their hospitalization, with an average rate of 0.94 units per day.The researchers emphasized that inequitable delivery of rehabilitation services to older adults with social or economic disadvantage may contribute to missed opportunities for improving long-term functional outcomes and downstream disparities in disability.
