Patient-related predictors of rehabilitation use for community-dwelling older Americans

Abstract

Objective: To determine patient factors that predict use of physical or occupational therapy (PT/OT) services by elderly people.

Design: Time-series study of the relationship of PT/OT use to a variety of characteristics present at baseline.

Participants: Eight-hundred nine community-dwelling men and women aged 65 and older.

Setting: The Medicare Screening and Health Promotion Trial at UCLA.

Main outcome measures: Use of PT/OT services, as reported in a telephone survey 1 year after initial information was obtained on the same subjects by the baseline telephonic survey.

Results: Fifteen percent of the sample used PT/OT within 12 months of baseline. In multiple logistic regression analysis, PT/OT use was significantly less frequent among racial minorities, less well educated groups, and the oldest age group. PT/OT use was higher among those who had both functional disability and the presence of arthritis, heart or lung disease, or a prior history of stroke. However, neither functional disability alone nor the presence of arthritis, cardiovascular or lung disease, in the absence of limited functioning, was associated with PT/OT use. Patients who had obtained a pneumococcal vaccination or used transportation services were also more likely to receive PT/OT.

Conclusions: Our findings suggest that there may be important sociodemographic inequalities in the use of rehabilitation services and raise the possibility of inappropriate underuse in certain subgroups. Additional studies are needed to determine whether similar inequalities of PT/OT use are found in other populations and whether rehabilitation is effective in various subgroups.