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

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

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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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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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

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.
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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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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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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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 (CI) were estimated for each comparison. Setting: Home or community rehabilitation environments PARTICIPANTS: A cohort of 5,274 home or community-based rehabilitation users aged 70 years or older, 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 of 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 to 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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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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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
ISSN	2168-6106
DOI	10.1001/jamainternmed.2021.8569
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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
ISSN (online)	2168-6114
ISSN	2168-6106
DOI	10.1001/jamainternmed.2021.0398
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Article: Associations between social isolation and diet quality among US adults with disability participating in the National Health and Nutrition Examination Survey, 2013-2018.

Saif, Nadia T / Addison, Odessa R / Hughes Barry, Kathryn / Falvey, Jason R / Parker, Elizabeth A

Preventive medicine reports

2023 Volume 36, Page(s) 102413

Abstract: Social isolation and disability are established risk factors for poor nutrition. We aimed to assess whether social isolation is associated with diet quality specifically among adults with disabilities. This cross-sectional analysis used data from the ... ...

Abstract	Social isolation and disability are established risk factors for poor nutrition. We aimed to assess whether social isolation is associated with diet quality specifically among adults with disabilities. This cross-sectional analysis used data from the National Health and Nutrition Examination Survey, 2013-2018. Adults with a disability, who were not pregnant, breastfeeding, or missing dietary intake data were included (n = 5,167). Disability was defined as a physical functioning limitation based on difficulty with any activities of daily living, instrumental activities of daily living, lower extremity mobility activities, or general physical activities. The Healthy Eating Index (HEI)-2015 measured diet quality; higher scores correspond to higher diet quality. We computed a social isolation index by summing single status, living alone, and two social engagement difficulty measures (one point for each component met; maximum 4 points). Multivariable linear regression, controlling for demographic and health covariates, estimated differences in HEI scores for dietary intake data, by social isolation score. Over half of HEI scores were < 51, corresponding to "poor" diet quality. Higher social isolation score was associated with lower vegetable and seafood/plant proteins intake. Single status and one of two social engagement measures were associated with lower scores on certain adequacy components. Differences were modest. There was little evidence of effect modification by age or gender. Adults with disabilities are not meeting national dietary standards; improving diet quality is a priority. Whether social isolation is associated with specific dietary components in this population requires further investigation. Further research is also needed among younger adults.
Language	English
Publishing date	2023-09-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2785569-7
ISSN	2211-3355
ISSN	2211-3355
DOI	10.1016/j.pmedr.2023.102413
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