Older Stroke Survivors in Home Care: Factors Associated with the use of CCAC Rehabilitation Services

Health Studies and Gerontology;Stroke;Home Care;Rehabilitation;Health Studies and Gerontology

Bucek, Jennifer

University of Waterloo

关键词: Health Studies and Gerontology;    Stroke;    Home Care;    Rehabilitation;    Health Studies and Gerontology;   

Others  :  https://uwspace.uwaterloo.ca/bitstream/10012/9237/3/Bucek_Jennifer.pdf

瑞士|英语

来源: UWSPACE Waterloo Institutional Repository

【 摘 要 】

Purpose: Despite improvements in the prevention and management of stroke, it continues to have asignificant impact on the Canadian population. For individuals who have suffered a stroke,rehabilitation is an important part of post stroke care that can maximize quality of life by reducing theimpact of stroke-related impairments and disability. The purpose of this thesis was to describe theprofile of older adults with stroke receiving home care services and to examine relationship betweencharacteristics of these individuals and their use of home care rehabilitation services (PT and OT).Information from interRAI home care assessments (RAI-HC and interRAI CA) was used and theAndersen Newman Behavioural model was employed as a conceptual framework.Methods: Two retrospective cohort studies of older stroke survivors receiving services from theHamilton Niagara Haldimand Brant Community Care Access Centre were conducted. Individualswith acute stroke were identified from hospital discharge records (Discharge Abstract Database) thatwere linked to interRAI assessments (RAI-HC N=1,181 and interRAI CA N=573), and CCACservice utilization data to identify the use of PT and OT services. Both samples were compared with anon-stroke population in order to describe the characteristics of those with stroke. Logistic regressionwas used to examine associations between independent variables and the use of services for PT andOT and ordinal logistic regression was used to assess relationships between characteristics and thenumber of PT/OT visits (0, 1-4, 5+) in both samples.Results: Comparison with the general older population revealed that older stroke survivors hadgreater difficulty with communication, swallowing, IADLs, ADLs, and a greater prevalence ofcognitive impairment. Following RAI-HC assessment those with unsteady gait and difficulty withstairs were more likely to receive PT and OT services. Impairment in ADLs and triggering the HomeEnvironment Optimization CAP were significantly associated with receiving OT. Being married andreceiving a greater amount of informal care increased the odds of receiving PT services, whilecognitive impairment and having Alzheimer’s disease or dementia decreased the odds of receivingPT. Significant variation by CCAC branch was also found. Male sex, language other than English,location of intake, cognitive decline, and unstable health were significantly associated with the use ofOT services among those assessed with the interRAI CA. Referral for rehabilitation, cognitivedecline, co-residing caregiver, and difficulty with locomotion were significantly associated with theuse of PT services after assessment with the interRAI CA. Comparison of predisposing, enabling, andneed factors revealed that need factors were the primary determinant of service use in this population,although enabling factors also played an important role.Conclusions: Older stroke survivors receiving home care services are a complex population with ahigh need for rehabilitation services. A better understanding of the characteristics of older strokesurvivors and their use of home care services can help to inform the provision of services to thispopulation to facilitate community reintegration and enhance quality of life.