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Published on: September 30, 2020
Association of Intensive Cognitive Rehabilitation With Discharge to Home
Seigo Mitsutake1, Takumi Hirata1, Masahiro Akishita2
1Human Care Research Team, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Tokyo, Japan.
Objectives:
To examine the association between intensive cognitive rehabilitation services (cognitive rehabilitation) and return-to-home rates among geriatric health service facilities (facilities) in Japan.
Design:
Cross-sectional observational study.
Setting And Participants:
A nationwide facility-level survey of facilities was conducted from December 2024 to February 2025. Of 3532 facilities registered with the Japan Association of Geriatric Health Services Facilities, 527 responded.
Methods:
The primary analysis included facilities providing intensive physical rehabilitation services (physical rehabilitation). Facilities were categorized as providing or not providing cognitive rehabilitation based on survey responses indicating whether they had claimed the cognitive rehabilitation add-on between April and October 2024. The outcome was the October 2024 return-to-home rate. Covariates included ownership, facility size, percentages of residents with high care dependency and severe cognitive functional impairment, percentages of residents requiring suctioning and enteral nutrition, add-on payments related to return to home, and staffing levels. The association between cognitive rehabilitation and return-to-home rate was analyzed using an ordinary least squares linear regression model with robust SEs, adjusted for all covariates.
Results:
Data from 434 facilities were analyzed. The mean return-to-home rate among all facilities was 42.0% (SD, 21.5; median, 42.0%); 264 (60.8%) facilities provided cognitive rehabilitation, whereas 170 (39.2%) did not. The return-to-home rate was higher in facilities that provided cognitive rehabilitation than in those that did not (45.5% vs 36.6%; P < .01). After adjusting for all covariates, the return-to-home rate of facilities providing cognitive rehabilitation was higher by 5.41 percentage points than that of facilities not providing cognitive rehabilitation (95% CI, 0.93-9.90). Sensitivity analyses, which expanded the sample to include facilities not providing physical rehabilitation, yielded estimates of similar magnitude and direction, supporting robustness.
Conclusions And Implications:
Provision of cognitive rehabilitation is associated with higher return-to-home rates, suggesting that long-term care systems should facilitate its implementation.
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