Older Stroke Survivors in Home Care: Factors Associated with the use of CCAC Rehabilitation Services
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Purpose: Despite improvements in the prevention and management of stroke, it continues to have a significant 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 the impact of stroke-related impairments and disability. The purpose of this thesis was to describe the profile of older adults with stroke receiving home care services and to examine relationship between characteristics 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 the Andersen Newman Behavioural model was employed as a conceptual framework. Methods: Two retrospective cohort studies of older stroke survivors receiving services from the Hamilton Niagara Haldimand Brant Community Care Access Centre were conducted. Individuals with acute stroke were identified from hospital discharge records (Discharge Abstract Database) that were linked to interRAI assessments (RAI-HC N=1,181 and interRAI CA N=573), and CCAC service utilization data to identify the use of PT and OT services. Both samples were compared with a non-stroke population in order to describe the characteristics of those with stroke. Logistic regression was used to examine associations between independent variables and the use of services for PT and OT and ordinal logistic regression was used to assess relationships between characteristics and the number of PT/OT visits (0, 1-4, 5+) in both samples. Results: Comparison with the general older population revealed that older stroke survivors had greater difficulty with communication, swallowing, IADLs, ADLs, and a greater prevalence of cognitive impairment. Following RAI-HC assessment those with unsteady gait and difficulty with stairs were more likely to receive PT and OT services. Impairment in ADLs and triggering the Home Environment Optimization CAP were significantly associated with receiving OT. Being married and receiving a greater amount of informal care increased the odds of receiving PT services, while cognitive impairment and having Alzheimer’s disease or dementia decreased the odds of receiving PT. 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 of OT services among those assessed with the interRAI CA. Referral for rehabilitation, cognitive decline, co-residing caregiver, and difficulty with locomotion were significantly associated with the use of PT services after assessment with the interRAI CA. Comparison of predisposing, enabling, and need 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 a high need for rehabilitation services. A better understanding of the characteristics of older stroke survivors and their use of home care services can help to inform the provision of services to this population to facilitate community reintegration and enhance quality of life.