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  1. Article ; Online: Trajectories of Recovery Following Traumatic Brain Injury Among Older Medicare Beneficiaries.

    Albrecht, Jennifer S / Chen, Chixiang / Falvey, Jason R

    Journal of neurotrauma

    2024  

    Abstract: It is well-known that older adults have poorer recovery following traumatic brain injury (TBI) relative to younger adults with similar injury severity. However, most older adults do recover well from TBI. Identifying those at increased risk of poor ... ...

    Abstract It is well-known that older adults have poorer recovery following traumatic brain injury (TBI) relative to younger adults with similar injury severity. However, most older adults do recover well from TBI. Identifying those at increased risk of poor recovery could inform appropriate management pathways, facilitate discussions about palliative care or unmet needs, and permit targeted intervention to optimize quality of life or recovery. We sought to explore heterogeneity in recovery from TBI among older adults as measured by home time per month, a patient-centered metric defined as time spent at home and not in a hospital, urgent care, or other facility. Using data obtained from Medicare administrative claims data for years 2010-2018, group-based trajectory modeling was employed to identify unique trajectories of recovery among a sample of United States adults age 65 and older who were hospitalized with TBI. We next determined which patient-level characteristics discriminated poor from favorable recovery using logistic regression. Among 20,350 beneficiaries, four unique trajectories were identified: poor recovery (
    Language English
    Publishing date 2024-02-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 645092-1
    ISSN 1557-9042 ; 0897-7151
    ISSN (online) 1557-9042
    ISSN 0897-7151
    DOI 10.1089/neu.2023.0502
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  2. Article ; Online: Community Mobility Among Older Adults Who Are Socioeconomically Disadvantaged: Addressing the Poverty Penalty.

    Twardzik, Erica / Guralnik, Jack M / Falvey, Jason R

    Physical therapy

    2023  

    Language English
    Publishing date 2023-12-29
    Publishing country United States
    Document type Journal Article
    ZDB-ID 415886-6
    ISSN 1538-6724 ; 0031-9023
    ISSN (online) 1538-6724
    ISSN 0031-9023
    DOI 10.1093/ptj/pzad182
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  3. Article ; Online: Impact of dementia and socioeconomic disadvantage on days at home after traumatic brain injury among older Medicare beneficiaries: A cohort study.

    Albrecht, Jennifer S / Scherf, Ana / Ryan, Kathleen A / Falvey, Jason R

    Alzheimer's & dementia : the journal of the Alzheimer's Association

    2024  Volume 20, Issue 4, Page(s) 2364–2372

    Abstract: Introduction: Time spent at home may aid in understanding recovery following traumatic brain injury (TBI) among older adults, including those with Alzheimer's disease and related dementias (ADRD). We examined the impact of ADRD on recovery following TBI ...

    Abstract Introduction: Time spent at home may aid in understanding recovery following traumatic brain injury (TBI) among older adults, including those with Alzheimer's disease and related dementias (ADRD). We examined the impact of ADRD on recovery following TBI and determined whether socioeconomic disadvantages moderated the impact of ADRD.
    Methods: We analyzed Medicare beneficiaries aged ≥65 years diagnosed with TBI in 2010-2018. Home time was calculated by subtracting days spent in a care environment or deceased from total follow-up, and dual eligibility for Medicaid was a proxy for socioeconomic disadvantage.
    Results: A total of 2463 of 20,350 participants (12.1%) had both a diagnosis of ADRD and were Medicaid dual-eligible. Beneficiaries with ADRD and Medicaid spent markedly fewer days at home following TBI compared to beneficiaries without either condition (rate ratio 0.66; 95% confidence interval [CI] 0.64, 0.69).
    Discussion: TBI resulted in a significant loss of home time over the year following injury among older adults with ADRD, particularly for those who were economically vulnerable.
    Highlights: Remaining at home after serious injuries such as fall-related traumatic brain injury (TBI) is an important goal for older adults. No prior research has evaluated how ADRD impacts time spent at home after TBI. Older TBI survivors with ADRD may be especially vulnerable to loss of home time if socioeconomically disadvantaged. We assessed the impact of ADRD and poverty on a novel DAH measure after TBI. ADRD-related disparities in DAH were significantly magnified among those living with socioeconomic disadvantage, suggesting a need for more tailored care approaches.
    MeSH term(s) Aged ; Humans ; United States/epidemiology ; Medicare ; Cohort Studies ; Socioeconomic Disparities in Health ; Alzheimer Disease/diagnosis ; Brain Injuries, Traumatic/epidemiology ; Retrospective Studies
    Language English
    Publishing date 2024-01-31
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2211627-8
    ISSN 1552-5279 ; 1552-5260
    ISSN (online) 1552-5279
    ISSN 1552-5260
    DOI 10.1002/alz.13666
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  4. Article ; Online: Association Between Race and Receipt of Home- and Community-Based Rehabilitation After Traumatic Brain Injury Among Older Medicare Beneficiaries.

    Albrecht, Jennifer S / Kumar, Amit / Falvey, Jason R

    JAMA surgery

    2023  Volume 158, Issue 4, Page(s) 350–358

    Abstract: Importance: Non-Hispanic Black (hereafter Black) patients with traumatic brain injury (TBI) experience worse long-term outcomes and residual disability compared with non-Hispanic White (hereafter White) patients. Receipt of appropriate rehabilitation ... ...

    Abstract Importance: Non-Hispanic Black (hereafter Black) patients with traumatic brain injury (TBI) experience worse long-term outcomes and residual disability compared with non-Hispanic White (hereafter White) patients. Receipt of appropriate rehabilitation can improve function among older adults after TBI.
    Objective: To assess the association between race and receipt of home- and community-based rehabilitation among a nationally representative sample of older Medicare beneficiaries with TBI.
    Design, setting, and participants: This cohort study analyzed a random sample of Medicare administrative claims data for community-dwelling Medicare beneficiaries aged 65 years or older who were hospitalized with a primary diagnosis of TBI and discharged alive to a nonhospice setting from 2010 through 2018. Claims data for Medicare beneficiaries of other races and ethnicities were excluded due to the small sample sizes within each category. Data were analyzed January 21 to August 30, 2022.
    Exposures: Black or White race.
    Main outcomes and measures: Monthly use rates of home-based or outpatient rehabilitation were calculated over the 6 months after discharge from the hospital. The denominator for rate calculations accounted for variation in length of hospital and rehabilitation facility stays and loss to follow-up due to death. Rates over time were modeled using generalized estimating equations, controlling for TBI acuity, demographic characteristics, comorbidities, and socioeconomic factors.
    Results: Among 19 026 Medicare beneficiaries (mean [SD] age, 81.6 [8.1] years; 10 781 women [56.7%]; and 994 Black beneficiaries [5.2%] and 18 032 White beneficiaries [94.8%]), receipt of 1 or more home health rehabilitation visits did not differ by race (Black vs White, 47.4% vs 46.2%; P = .46), but Black beneficiaries were less likely to receive 1 or more outpatient rehabilitation visits compared with White beneficiaries (3.4% vs 7.1%; P < .001). In fully adjusted regression models, Black beneficiaries received less outpatient therapy over the 6 months after TBI (rate ratio, 0.60; 95% CI, 0.38-0.93). However, Black beneficiaries received more home health rehabilitation therapy over the 6 months after TBI than White beneficiaries (rate ratio, 1.15; 95% CI, 1.00-1.32).
    Conclusions and relevance: This cohort study found relative shifts in rehabilitation use, with markedly lower outpatient therapy use and modestly higher home health care use among Black patients compared with White patients with TBI. These disparities may contribute to reduced functional recovery and residual disability among racial and ethnic minority groups. Additional studies are needed to assess the association between the amount of outpatient rehabilitation care and functional recovery after TBI in socioeconomically disadvantaged populations.
    MeSH term(s) Aged ; Humans ; Female ; United States ; Aged, 80 and over ; Medicare ; Ethnicity ; Cohort Studies ; Minority Groups ; Brain Injuries, Traumatic ; Retrospective Studies
    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2701841-6
    ISSN 2168-6262 ; 2168-6254
    ISSN (online) 2168-6262
    ISSN 2168-6254
    DOI 10.1001/jamasurg.2022.7081
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  5. Article ; Online: Deconditioned, disabled, or debilitated? Formalizing management of functional mobility impairments in the medical inpatient setting.

    Martinez, Maylyn / Falvey, Jason R / Cifu, Adam

    Journal of hospital medicine

    2022  Volume 17, Issue 10, Page(s) 843–846

    MeSH term(s) Aged ; Disabled Persons ; Frail Elderly ; Humans ; Inpatients
    Language English
    Publishing date 2022-07-11
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2233783-0
    ISSN 1553-5606 ; 1553-5592
    ISSN (online) 1553-5606
    ISSN 1553-5592
    DOI 10.1002/jhm.12910
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  6. Article ; Online: Demystifying the Digital Divide: Disparities in Telerehabilitation Readiness Among Older Adults in the United States.

    Falvey, Jason R / Sun, Na / Miller, Matthew J / Pravdo, Alisa / Mullins, C Daniel

    Archives of physical medicine and rehabilitation

    2024  

    Abstract: Objective: To estimate readiness of older rehabilitation users in the United States to participate in video-based telerehabilitation and assess disparities in readiness among racial and ethnic minoritized populations, socioeconomically disadvantaged ... ...

    Abstract Objective: To estimate readiness of older rehabilitation users in the United States to participate in video-based telerehabilitation and assess disparities in readiness among racial and ethnic minoritized populations, socioeconomically disadvantaged populations, and rural-dwelling older adults.
    Design: Retrospective cohort study using nationally representative survey data from the National Health and Aging Trends Study from 2015 and 2020. Survey-weighted regression models, accounting for complex survey design, were used to generate estimates of readiness and evaluate disparities across racial and ethnic, socioeconomic, and geographic subgroups. Odds ratios (OR) and 95% confidence intervals (CIs) were estimated for each comparison.
    Setting: Home or community rehabilitation environments.
    Participants: A cohort of 5274 home or community-based rehabilitation users aged 70 years or older (N=5274), representing a weighted 33,576,313 older adults in the United States.
    Interventions: Not applicable.
    Main outcome measure(s): Video-based telerehabilitation readiness was defined consistent with prior work; unreadiness was defined as lacking ownership of internet-enabled devices, limited proficiency of use, or living with severe cognitive, visual, or hearing impairment. Telerehabilitation readiness was categorized as "Ready" or "Unready".
    Results: Approximately 2 in 3 older rehabilitation users were categorized as ready to participate in video-based rehabilitation. Significantly lower rates of readiness were observed among those living in rural areas (OR=0.75, 95% CI: 0.60-0.94), financially strained individuals (OR=0.37, 95% CI: 0.26-0.53), and among individuals identifying as Black or Hispanic (as compared with non-Hispanic White older adults: Non-Hispanic Black [OR=0.23, 95% CI: 0.18-0.30]; Hispanic [OR=0.17, 95% CI: 0.11, 0.27]).
    Conclusions: Our findings highlight significant disparities in the readiness to uptake video-based telerehabilitation. Policy and practice interventions to address telerehabilitation readiness should focus not only on improving broadband access but also on technology ownership and training to ensure equitable adoption in populations with lower baseline readiness.
    Language English
    Publishing date 2024-03-28
    Publishing country United States
    Document type Journal Article
    ZDB-ID 80057-0
    ISSN 1532-821X ; 0003-9993
    ISSN (online) 1532-821X
    ISSN 0003-9993
    DOI 10.1016/j.apmr.2024.03.009
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  7. Article ; Online: Staffing and Antipsychotic Medication Use in Nursing Homes and Neighborhood Deprivation.

    Travers, Jasmine L / Hade, Erinn M / Friedman, Steven / Raval, Aasha / Hadson, Kimberly / Falvey, Jason R

    JAMA network open

    2024  Volume 7, Issue 4, Page(s) e248322

    Abstract: Importance: Inappropriate use of antipsychotic medications in nursing homes is a growing public health concern. Residents exposed to higher levels of socioeconomic deprivation in the area around a nursing home may be currently exposed, or have a long ... ...

    Abstract Importance: Inappropriate use of antipsychotic medications in nursing homes is a growing public health concern. Residents exposed to higher levels of socioeconomic deprivation in the area around a nursing home may be currently exposed, or have a long history of exposure, to more noise pollution, higher crime rates, and have less opportunities to safely go outside the facility, which may contribute to psychological stress and increased risk of receiving antipsychotic medications inappropriately. However, it is unclear whether neighborhood deprivation is associated with use of inappropriate antipsychotic medications and whether this outcome is different by facility staffing levels.
    Objective: To evaluate whether reported inappropriate antipsychotic medication use differs in severely and less severely deprived neighborhoods, and whether these differences are modified by higher levels of total nurse staffing.
    Design, setting, and participants: This was a cross-sectional analysis of a national sample of nursing homes that linked across 3 national large-scale data sets for the year 2019. Analyses were conducted between April and June 2023.
    Exposure: Neighborhood deprivation status (severe vs less severe) and total staffing hours (registered nurse, licensed practical nurse, certified nursing assistant).
    Main outcome and measures: This study estimated the association between neighborhood deprivation and the percentage of long-stay residents who received an antipsychotic medication inappropriately in the nursing home at least once in the past week and how this varied by nursing home staffing through generalized estimating equations. Analyses were conducted on the facility level and adjusted for state fixed effects.
    Results: This study included 10 966 nursing homes (1867 [17.0%] in severely deprived neighborhoods and 9099 [83.0%] in less deprived neighborhoods). Unadjusted inappropriate antipsychotic medication use was greater in nursing homes located in severely deprived neighborhoods (mean [SD], 15.9% [10.7%] of residents) than in those in less deprived neighborhoods (mean [SD], 14.2% [8.8%] of residents). In adjusted models, inappropriate antipsychotic medication use was higher in severely deprived neighborhoods vs less deprived neighborhoods (19.2% vs 17.1%; adjusted mean difference, 2.0 [95% CI, 0.35 to 3.71] percentage points) in nursing homes that fell below critical levels of staffing (less than 3 hours of nurse staffing per resident-day).
    Conclusions and relevance: These findings suggest that levels of staffing modify disparities seen in inappropriate antipsychotic medication use among nursing homes located in severely deprived neighborhoods compared with nursing homes in less deprived neighborhoods. These findings may have important implications for improving staffing in more severely deprived neighborhoods.
    MeSH term(s) Humans ; Nursing Homes/statistics & numerical data ; Antipsychotic Agents/therapeutic use ; Cross-Sectional Studies ; Male ; Female ; Aged ; Personnel Staffing and Scheduling/statistics & numerical data ; United States ; Residence Characteristics/statistics & numerical data ; Inappropriate Prescribing/statistics & numerical data ; Neighborhood Characteristics/statistics & numerical data
    Chemical Substances Antipsychotic Agents
    Language English
    Publishing date 2024-04-01
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2024.8322
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  8. Article ; Online: Flattening the disability curve: Rehabilitation and recovery after COVID-19 infection.

    Falvey, Jason R / Ferrante, Lauren E

    Heart & lung : the journal of critical care

    2020  Volume 49, Issue 5, Page(s) 440–441

    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Humans ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Subacute Care
    Keywords covid19
    Language English
    Publishing date 2020-05-11
    Publishing country United States
    Document type Editorial ; Research Support, N.I.H., Extramural ; Comment
    ZDB-ID 193129-5
    ISSN 1527-3288 ; 0147-9563
    ISSN (online) 1527-3288
    ISSN 0147-9563
    DOI 10.1016/j.hrtlng.2020.05.001
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  9. Article ; Online: Association of Financial Strain With Mortality Among Older US Adults Recovering From an Acute Myocardial Infarction.

    Falvey, Jason R / Hajduk, Alexandra M / Keys, Christopher R / Chaudhry, Sarwat I

    JAMA internal medicine

    2022  Volume 182, Issue 4, Page(s) 445–448

    MeSH term(s) Adult ; Aged ; Humans ; Middle Aged ; Myocardial Infarction ; Risk Factors
    Language English
    Publishing date 2022-02-21
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
    ISSN (online) 2168-6114
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    DOI 10.1001/jamainternmed.2021.8569
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  10. Article ; Online: Addressing Unmet Adaptive Equipment Needs Through Primary Care.

    McGarry, Brian E / Falvey, Jason R

    JAMA internal medicine

    2021  Volume 181, Issue 5, Page(s) 670–671

    MeSH term(s) Health Services Needs and Demand ; Humans ; Primary Health Care
    Language English
    Publishing date 2021-04-12
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 2699338-7
    ISSN 2168-6114 ; 2168-6106
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    ISSN 2168-6106
    DOI 10.1001/jamainternmed.2021.0398
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