Older Stroke Survivors in Home Care: Factors Associated with the use of CCAC Rehabilitation Services
Notice bibliographique
Résumé
Purpose: Despite improvements in the prevention and management of stroke, it continues to have a \nsignificant impact on the Canadian population. For individuals who have suffered a stroke, \nrehabilitation is an important part of post stroke care that can maximize quality of life by reducing the \nimpact of stroke-related impairments and disability. The purpose of this thesis was to describe the \nprofile of older adults with stroke receiving home care services and to examine relationship between \ncharacteristics of these individuals and their use of home care rehabilitation services (PT and OT). \nInformation from interRAI home care assessments (RAI-HC and interRAI CA) was used and the \nAndersen Newman Behavioural model was employed as a conceptual framework. \n \nMethods: Two retrospective cohort studies of older stroke survivors receiving services from the \nHamilton Niagara Haldimand Brant Community Care Access Centre were conducted. Individuals \nwith acute stroke were identified from hospital discharge records (Discharge Abstract Database) that \nwere linked to interRAI assessments (RAI-HC N=1,181 and interRAI CA N=573), and CCAC \nservice utilization data to identify the use of PT and OT services. Both samples were compared with a \nnon-stroke population in order to describe the characteristics of those with stroke. Logistic regression \nwas used to examine associations between independent variables and the use of services for PT and \nOT and ordinal logistic regression was used to assess relationships between characteristics and the \nnumber of PT/OT visits (0, 1-4, 5+) in both samples. \n \nResults: Comparison with the general older population revealed that older stroke survivors had \ngreater difficulty with communication, swallowing, IADLs, ADLs, and a greater prevalence of \ncognitive impairment. Following RAI-HC assessment those with unsteady gait and difficulty with \nstairs were more likely to receive PT and OT services. Impairment in ADLs and triggering the Home \nEnvironment Optimization CAP were significantly associated with receiving OT. Being married and \nreceiving a greater amount of informal care increased the odds of receiving PT services, while \ncognitive impairment and having Alzheimer’s disease or dementia decreased the odds of receiving \nPT. Significant variation by CCAC branch was also found. Male sex, language other than English, \nlocation of intake, cognitive decline, and unstable health were significantly associated with the use of \nOT services among those assessed with the interRAI CA. Referral for rehabilitation, cognitive \ndecline, co-residing caregiver, and difficulty with locomotion were significantly associated with the \nuse of PT services after assessment with the interRAI CA. Comparison of predisposing, enabling, and \nneed factors revealed that need factors were the primary determinant of service use in this population, \nalthough enabling factors also played an important role. \n \nConclusions: Older stroke survivors receiving home care services are a complex population with a \nhigh need for rehabilitation services. A better understanding of the characteristics of older stroke \nsurvivors and their use of home care services can help to inform the provision of services to this \npopulation to facilitate community reintegration and enhance quality of life.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».