Prevalence of cognitive impairment in home health physical therapy.

TitlePrevalence of cognitive impairment in home health physical therapy.
Publication TypeJournal Article
Year of PublicationForthcoming
AuthorsMiller, MJ, Cenzer, I, Barnes, DE, Ankuda, CK, Covinsky, KE
JournalJournal of the American Geriatrics Society
ISSN Number1532-5415
Keywordscognitive impairment, Dementia, home health, physical therapy, Rehabilitation
Abstract

BACKGROUND: The prevalence of cognitive impairment in home health physical therapy (HHPT) is unknown. We sought to identify the prevalence of cognitive impairment, including cognitive impairment no dementia (CIND) and dementia, among older adults who used HHPT, and if cognitive impairment prevalence was higher among those with HHPT-relevant characteristics.

METHODS: For our cross-sectional analysis, we identified 963 fee-for-service Medicare beneficiaries with HHPT claims (>85 years old: 28.8%, women: 63.7%, non-Hispanic White: 82.1%) in the 2014 and 2016 waves of the Health and Retirement Study (HRS) and used a validated algorithm to categorize cognitive status as normal, CIND, or dementia. We estimated the population prevalence and calculated age, gender, race/ethnicity adjusted odds ratio (aOR) of CIND and dementia for characteristics relevant to HHPT service delivery including depression, walking difficulty, fall history, incontinence, moderate-vigorous physical activity (MVPA) ≤1x/week, and community-initiated HHPT using multinomial logistic regression.

RESULTS: The population prevalence of cognitive impairment was 46.4% (CIND: 27.3%, dementia: 19.1%). The prevalence of cognitive impairment was greater among those with depression (46.7% vs. 39.5%), difficulty walking across the room (58.9% vs. 41.8%), fall history (49.1% vs. 42.9%), MVPA ≤1x/week (50.0% vs. 38.0%), and community-initiated HHPT (55.2% vs. 40.2%). Compared to normal cognitive status, the odds of cognitive impairment were greater for those with MVPA≤1x/week (CIND: aOR = 1.57 [95% CI: 1.05-2.33], dementia: aOR = 2.55 [95% CI: 1.54-4.22]), depression (dementia: aOR = 1.99 [95% CI: 1.19-3.30]), difficulty walking across the room (dementia: aOR = 2.54 [95% CI: 1.40-4.60]), fall history (dementia: aOR = 1.85 [95% CI: 1.20-2.83]), and community-initiated HHPT (dementia: aOR = 1.72 (95% CI: 1.13-2.61]).

CONCLUSION: There is a high prevalence of CIND and dementia in HHPT, and no characteristics had a low prevalence of cognitive impairment. Physical therapists should be ready to identify cognitive impairment and adapt home health service delivery for this vulnerable population of older adults.

DOI10.1111/jgs.18715
Citation Key13713
PubMed ID38152855
Grant ListKL2 TR001870 / TR / NCATS NIH HHS / United States
P30 AG044281 / NH / NIH HHS / United States
P01 AG066605 / NH / NIH HHS / United States
P01 AG066605 / AG / NIA NIH HHS / United States
K76 AG064427 / AG / NIA NIH HHS / United States
KL2TR001870 / NH / NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States
K76AG064427 / NH / NIH HHS / United States