Older Adults with SCI Navigating Recovery: Mobility Function, Social Factors, and Facility Characteristics - Traumatic spinal cord injury (TSCI) and Non- traumatic spinal cord injury (NTSCI) are significant health issues for older adults, who require higher utilization of hospital resources, experience pre-existing comorbidities, and have a higher incidence of morbidity and mortality compared to younger adults. Regardless of etiology, a SCI poses significant mobility challenges in older adults, including reduced functional independence, decreased walking ability, chronic pain, increased likelihood of disability, and increased risk of health complications. Furthermore, older adults living with SCI are challenged by understudied social factors that may be associated with mobility function, including social isolation, living alone, and having low health literacy. Since 2002, the Centers for Medicare & Medicaid Services has mandated the use of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), with Section GG – Functional Abilities, replacing the Functional Independence Measure (FIM) in 2019 to assess patients' mobility. However, research on social factors for spinal cord injury (SCI) patients remains limited, with most existing literature focused on the FIM. Current studies present inconsistent findings regarding the association of inpatient rehabilitation length of stay (LOS) and intensity on mobility outcomes for older adults with SCI. Moreover, the mobility and social factors in the IRF-PAI have not been thoroughly examined in this population, and there is a lack of comprehensive analyses on the influence of facility-level characteristics on mobility function, such as Commission on Accreditation of Rehabilitation Facilities (CARF) accreditation, US geographical location, and ownership status on patients' mobility function. I aim to address these gaps in the literature by examining mobility function in older US adults with SCI, analyzing treatment and social factors at the patient level, and evaluating how facility characteristics impact mobility outcomes. I will conduct a series of linear regressions using 2023 IRF-PAI claims data to meet the following specific aims: 1) Examine the association of LOS and intensity of rehabilitation therapy on mobility function (overall mobility measure, bed mobility, transfers, and gait) improvement from the time of inpatient rehabilitation admission to discharge in older adults, after adjusting for patients’ clinical characteristics and SCI etiology (TSCI vs NTSCI), stratified by neurologic category (level and completeness of injury); 2) Examine the association of social factors (low health literacy, social isolation, pre-hospital setting, and living situation) and mobility function (overall, bed mobility, transfers, and gait) in older adults stratified by SCI etiology and neurologic category (level and completeness of injury); and 3) Examine the association of facility-level characteristics (CARF accreditation, US geographic area, and ownership status) and mobility function (overall, bed mobility, transfers, and gait) in older adults stratified by SCI etiology and neurologic category (level and completeness of injury). The study will analyze a diverse national sample of older Medicare beneficiaries with SCI. This innovative approach addresses the underrepresentation of older adults with SCI in current mobility function studies and will be the first to compare IRF-PAI mobility measures at the facility level for SCI. The research aligns with the priorities of the Merit Switzer Research Fellowships and NIDILRR's outcome domains by addressing community living and participation, and health and function. It focuses on the lived experiences of older adults with SCI navigating the US healthcare system during inpatient rehabilitation, examining clinical and social factors affecting mobility function. This approach supports NIDILRR's 2024-2028 Long-Range Plan by growing disability and rehabilitation research, highlighting anti-ableist research, and assessing system-level variables
