Rehabilitation engagement is associated with lower level of care needs on discharge from postacute care in older adults with cognitive impairment.

IF 1.9 4区医学 Q3 PSYCHOLOGY, CLINICAL

Rehabilitation Psychology Pub Date : 2025-05-12 DOI:10.1037/rep0000625

Emily T Noyes, Jinkyung Ha, Neil B Alexander, Robert V Hogikyan, Robert J Spencer, Julija Stelmokas

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引用次数: 0

Abstract

Purpose/objective: Older adults with cognitive impairment (CI) in postacute care (PAC) are at risk for an increased level of care (LOC) postdischarge. Rehabilitation engagement may impact the relationship between CI and increased LOC.

Research method/design: Ninety-two older veterans (> 50 years) were assessed by physical therapists or assistants with the Hopkins Rehabilitation Engagement Rating Scale (HRERS) while participating in Veterans Affairs PAC. Hierarchical logistic regression examined whether rehabilitation engagement predicted LOC while controlling for cognition as assessed with the Montreal Cognitive Assessment (MoCA). We then examined whether rehabilitation engagement moderated the effect of cognition on LOC.

Results: Hierarchical logistic regression modeling revealed that the HRERS total score predicted LOC after controlling for MoCA scores. The interaction between MoCA and HRERS total score was nonsignificant. Item-level HRERS analyses revealed a significant interaction for CI (MoCA score < 22) and active participation (HRERS Item 5). Examination of the interaction indicated that among low scorers on active participation, CI increased the odds of requiring higher LOC, while the main effect of CI on LOC was nonsignificant among those who scored high on active participation.

Conclusion/implications: Higher rehabilitation engagement reduced the risk of requiring higher LOC at PAC discharge after controlling for cognitive functioning. Additionally, active participation may buffer against adverse outcomes for older adults with CI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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康复参与与老年认知障碍患者急性期后出院时较低的护理需求相关。

目的/目的：急性后护理（PAC）中认知障碍（CI）的老年人在出院后护理水平（LOC）增加的风险。康复参与可能影响CI与LOC增加之间的关系。研究方法/设计：92名老年退伍军人（60 - 50岁）在参加退伍军人事务PAC时，由物理治疗师或助理使用霍普金斯康复参与评定量表（hrs）进行评估。分层逻辑回归检验康复参与是否预测LOC，同时控制蒙特利尔认知评估（MoCA）的认知。然后，我们研究了康复参与是否会调节认知对LOC的影响。结果：层次逻辑回归模型显示，在控制MoCA评分后，hrs总分预测LOC。MoCA与hrs总分的交互作用不显著。项目水平的hrs分析显示，CI （MoCA评分< 22）和积极参与（hrs项目5）之间存在显著的相互作用。对相互作用的检验表明，在积极参与得分低的学生中，CI增加了要求更高LOC的几率，而在积极参与得分高的学生中，CI对LOC的主要影响不显著。结论/意义：在控制认知功能后，更高的康复参与度降低了PAC放电时需要更高LOC的风险。此外，积极参与可以缓冲老年CI患者的不良后果。（PsycInfo Database Record (c) 2025 APA，版权所有）。

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来源期刊

Rehabilitation Psychology Multiple-

CiteScore

4.80

自引率

7.40%

发文量

期刊介绍： Rehabilitation Psychology is a quarterly peer-reviewed journal that publishes articles in furtherance of the mission of Division 22 (Rehabilitation Psychology) of the American Psychological Association and to advance the science and practice of rehabilitation psychology. Rehabilitation psychologists consider the entire network of biological, psychological, social, environmental, and political factors that affect the functioning of persons with disabilities or chronic illness. Given the breadth of rehabilitation psychology, the journal"s scope is broadly defined.