Risk factors for inpatient facility admission among home health care patients with diabetes.

BACKGROUND: Home health care (HHC) patients with diabetes are at high risk for inpatient admissions. PURPOSE: To identify variables associated with inpatient admissions among adults age ≥50 with diabetes receiving HHC in the community and in assisted living (AL). METHODS: Retrospective HHC data (collected October 2021 to March 2022 in the Southern United States) from the Outcome and Assessment Information Set D were analyzed with logistic regression (n = 5,308 patients). DISCUSSION: The inpatient admission rate was 29.5%. For community-dwelling patients, multiple hospitalizations, depression, limited cognitive function, decreased activities of daily living (ADL) performance, and unhealed pressure ulcer or injury ≥stage 2 were significantly associated with inpatient admission. For those in AL, multiple prior hospitalizations and decreased ability to perform ADLs were associated with inpatient admission. CONCLUSION: Understanding risk factors for inpatient admissions among patients with diabetes can support the identification of at-risk patients and inform interventions.

Effect of home-based rehabilitation on activities of daily living and gait in older adults with heart failure at risk for falling: A retrospective cohort study.

PURPOSE: The purpose of this study is to describe improvement in activities of daily living (ADL) and gait speed, and associated factors in subjects receiving home-based rehabilitation after hospital admission for heart failure. METHODS: A total of 1,055 patients (mean age 82 ± 8 years SD) receiving post-admission home care services for heart failure. Subjects were included if they were referred for home-care rehabilitation after inpatient admission with ICD-9 code indicating heart failure at inpatient discharge, primary home care, or co-morbid diagnosis on admission Outcome and Assessment Information Set version-C (OASIS-C). Change in total ADL score was described and adjusted for significant baseline factors/covariates using a generalized linear model. Factors predictive of exceeding the ADL score Minimal Detectable Change (MDC) were identified with multiple variable logistic regression. RESULTS: Mean change in total ADL score from admission to discharge was 1.6 ± 1.2, the mean change for gait speed was 0.17 ± 0.21 m/s, and the minimum detectable change (MDC) (1.3) was exceeded by 57% of subjects. Improvement in mean ADL score was significantly predicted by age, baseline total ADL score, baseline gait speed score, cognitive-behavioral status, and living situation (R2 = 42%). CONCLUSIONS: Patients with heart failure receiving home-based rehabilitation services make significant improvements in ADL function and gait performance. Greater ADL improvements are associated with younger age, faster gait speed at baseline, and greater impairment of baseline ADL scores. Age, baseline gait speed, and ADL composite score are significantly related to making a change beyond measurement error in ADL change score.

Outcomes of usual versus a specialized falls and balance program in the home.

A retrospective cohort study with adjustment for baseline group differences was conducted to determine if there was a difference in Outcome and Information Data Set (OASIS-C) activities of daily living (ADL) outcomes as well as the duration and number of home care visits between usual home care rehabilitation services and a home care rehabilitation team that was specially trained in falls identification and prevention. Data from adult Medicare beneficiaries who were treated in a large multistate home care practice with at least one visit by a physical therapist were retrieved retrospectively for analysis (n = 3,907 records). Patients identified as having multiple fall risk factors based on OASIS-C assessment undergoing a specialized care program demonstrated greater improvements in mean total ADL scores after home healthcare rehabilitation services compared with subjects at fall risk receiving usual care. Interdisciplinary care delivered by a healthcare team specially trained in fall prevention appeared to decrease the number of home care visits and resulted in improved ADL OASIS-C outcome scores after adjustment for potential confounders.

Predictors of functional and gait outcomes for persons poststroke undergoing home-based rehabilitation.

BACKGROUND: The literature on the impact of home-based rehabilitation on functional outcomes for patients after stroke is limited. The purpose of this study was to describe the outcomes of home-based rehabilitation (HBR) on functional and gait performance for patients after stroke and associated factors that contribute to better outcomes after an episode of care. METHODS: The nature of the study design was retrospective and the settings used were home care services. The total number of subjects receiving home care services after stroke was 213 (mean age 76.5 ± 9 years, 51% female). Treatment records for patients receiving HBR in 2010 were reviewed at the start of care and discharge. The primary outcome measure was a change in a gait speed and activities of daily living (ADL) performance between admission and discharge from home health care services. The composite score to calculate overall functional status (Outcome Information and Assessment Set-version C [OASIS-C]) was used. Mean change in ADL and gait scores and factors predictive of improvement were identified using an analysis of covariance and multivariate linear models. The main outcome measures were change in the OASIS-C composite scores and gait speed. RESULTS: After adjustment for age and ADL score at the start of care, discharge from skilled nursing or long-term facilities, presence of confusion most of the times, cognitive impairment, and memory deficits were negatively associated with an improvement in functional scores (ADL). Living in congregate facilities was also negatively associated with an improvement in gait speed. The best multivariate model included age, baseline ADL composite scores, confusion status, and gait speed at the start of care, which predicted 41% of the variance in ADL score changes over the course of intervention. CONCLUSIONS: Gait speed and ADL scores at the start of care had largest influence on functional and gait improvement. Type of discharge facility, confusion status, and living arrangement had effects on HBR outcomes for stroke survivors.

Improvements in balance in older adults engaged in a specialized home care falls prevention program.

BACKGROUND AND PURPOSE: To determine if persons older than 65 years receiving a combination of physical therapy, occupational therapy, speech, or nursing interventions in their home demonstrated changes in gait/balance function after an episode of home care services. METHODS: Charts from 11 667 persons who were at risk for falling and who were participating in an exercise program in the home were included. STUDY DESIGN: Data were retrieved from the Outcome and Assessment Information Set, Version B, and the computerized database of physical therapist-collected outcome data. Recorded physical therapist-data may have included a neuropathic pain rating, the Berg Balance Scale (BBS), the Performance Oriented Measurement Assessment (POMA), the Dynamic Gait Index (DGI), and the modified Clinical Test of Sensory Integration and Balance (mCTSIB). DATA ANALYSIS: Data were extracted by an honest broker and were analyzed. Mean (SD) change in each performance test and the percentage of participants in the total sample and in the 9 age/health condition strata that exceeded the minimum detectable change (MDC) for each gait/balance measure were described. The value of MDC95 describes the amount of true change in participant status beyond measurement error with 95% certainty. RESULTS: The gait/balance measures demonstrated MDCs ranging between 68% and 91% for the study sample. Mean (SD) of improvement on the BBS was 12 (8) points, with 88% of all participants exceeding the BBS MDC95 value of 5 points. Mean (SD) of improvement in gait/balance performance as measured by the POMA was 8 (4) points, with 91% of all participants exceeding the POMA MDC95 value of 3 points. Among all patients, mean (SD) of improvement on the DGI was 7 (4) points with 91% of all participants exceeding the DGI MDC95 value of 2 points by discharge. At admission, the median number of mCTSIB conditions that could be completed was 1 and the median number of completed conditions on the mCTSIB increased to 3 at discharge, with 81% of all participants demonstrating improvement. CONCLUSION: On the basis of established criteria, participants seemed to make clinically meaningful gains after the home care episode of care.

Relationship between cognition and gait performance in older adults receiving physical therapy interventions in the home.

Persons undergoing physical therapy home services often have difficulty with mobility and gait. The purpose of this study was to determine whether there was a relationship between gait and a rating of cognitive functioning in persons undergoing home-care physical therapy services. Patients over the age of 65 (n = 11,601) seen by a home-care agency between 2007 and 2008 were included in the retrospective analysis, and 10,953 (mean +/- standard deviation age 83.2 +/- 7.1; 31%) met the criteria of being able to ambulate independently or with an assistive device. All patients attempted to perform the modified Clinical Test of Sensory Integration and Balance plus either the Performance Oriented Measurement Assessment (POMA) or the Dynamic Gait Index (DGI). Mental function was scored as part of the Outcome and Assessment Information Set. A multivariate model with adjustment for age and sex identified gait performance as measured by the DGI to be independently associated with the likelihood that a patient required cognitive prompting (p = 0.03). Both the DGI and POMA scores were independently associated with requiring assistance/dependence with cognitive tasks. There was a strong relationship between cognition and gait performance in persons undergoing physical therapy interventions in the home. Changes in gait may be related to cognitive decline.