Some older adults receive no outpatient rehabilitation or home health care following acute care hospitalization and community discharge
By Lori Solomon HealthDay Reporter
TUESDAY, March 18, 2025 (HealthDay News) — Disparities exist in access to rehabilitation following community discharge for traumatic brain injury (TBI) in older adults based on contextual-level social determinants of health (SDoH), according to a study published online in the March/April issue of the Journal of Head Trauma Rehabilitation.
Chinedu Onwudebe, from the University of Texas Medical Branch at Galveston, and colleagues examined the association between contextual SDoH and receipt of first outpatient or home health (HH) rehabilitation visit after hospital discharge (2014 through 2018) among 19,117 older adult Medicare fee-for-service beneficiaries (aged 66 years and older) with TBI in Texas.
The researchers found that patients living in areas with higher median household incomes (hazard ratio [HR], 0.92) and higher unemployment rates (HR, 0.98) had a decreased likelihood of having an HH visit upon return to community, while those with higher uninsured rates (HR, 0.78) and in rural areas (HR, 0.83) had a decreased likelihood of having an outpatient visit. There was an increased likelihood of having an HH visit with Food Environment Index (HR, 1.08). A higher percentage with severe housing problems (HR, 1.34) increased the likelihood of an outpatient visit. Contextual-level SDoH was associated with a decreased likelihood of an outpatient visit but an increased likelihood of an HH visit, when they were treated as competing events. Overall, more than a third of the older adults received no outpatient rehabilitation or HH care.
“The varying utilization of HH versus outpatient rehabilitation indicates that structural determinants of health inequities, such as policies and practices (e.g., dictating care plans), intermediate determinants, such as the built, natural, and sociocultural environment (e.g., access to food, housing), as well as intrapersonal determinants, such as health literacy and care preferences, may exacerbate the identified differences in access to care,” the authors write.
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