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

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 (DAAH 100 ) after ICU hospitalization among older adults and evaluate whether in-hospital rehabilitation is associated with improved DAAH 100 .

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 DAAH 100 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 DAAH 100 (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 DAAH 100 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 DAAH 100 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 DAAH 100 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.