Older Stroke Survivors in Home Care: Factors Associated with the use of CCAC Rehabilitation Services
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".