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