Days Alive and at Home After Critical Illness Hospitalization Among Older Adults and Its Association With Delivery of In-Hospital Rehabilitation.

Abstract

Older adults hospitalized to the ICU are at risk for functional decline. In-hospital rehabilitation can mitigate functional decline; however, its association with long-term outcomes is unknown. Our objective was to describe days alive and at home (DAAH) in the 100 days (DAAH100) after ICU hospitalization among older adults and evaluate whether in-hospital rehabilitation is associated with improved DAAH100. Retrospective cohort study. National Health and Aging Trends Study linked with Medicare claims (2011-2019). Community-dwelling Medicare beneficiaries 65 years old or older who survived ICU hospitalization. None. The outcome DAAH100 was calculated by subtracting all post-discharge days in any of emergency department, observation unit, inpatient medical, psychiatric, rehabilitation unit, skilled nursing or hospice facility, and post-death from 100. The exposure was units of in-hospital rehabilitation, that is, physical and/or occupational therapy. We constructed a proportional odds logistic regression model of DAAH100 (ordinal) adjusted for demographics, pre-hospitalization frailty and functional status, and hospitalization characteristics. We identified 884 ICU hospitalizations (weighted n = 5,330,486) of older adults discharged alive (age, median [interquartile range (IQR)]: 81 yr [75-86]; 50.5% female). Median DAAH100 was 95 (IQR: 58.4-100) with median of 4 units (~1 hr) of in-hospital rehabilitation delivered over 6 days. After adjustment, each hour of in-hospital rehabilitation was associated with 8% higher odds of experiencing any of the three highest levels of DAAH100 after discharge (adjusted odds ratio [95% CI], 1.08 [1.04-1.08]). In this nationally representative study of older ICU survivors, the average patient spent 95 of the first 100 post-discharge DAAH; delivery of greater amounts of in-hospital rehabilitation was associated with increased DAAH100 after discharge. These findings highlight the substantial heterogeneity in time spent at home by older ICU survivors and the potential for in-hospital rehabilitation to improve this important patient-centered outcome.