128 - National Trends in Use of Rehabilitation Services Among Older Adults in the US, 2015–2022

Objectives: Limited data is available on the national rehabilitation use among older adults over time. The objective of this study is to evaluate trends in rehabilitation utilization and patient-reported functional outcomes in Americans aged 65 and older.

Design: We conducted repeated cross-sectional analyses using data from the National Health and Aging Trends Study (NHATS) between 2015-2022. NHATS annually collected data on the health needs of a nationally representative sample of Medicare beneficiaries through standardized, in-person interviews and physical performance assessments. The outcomes of interest were patient-reported use of rehabilitation services in the 12 months preceding each interview and associated functional outcomes.

Results: Among 40,891 survey responses provided by 10,086 participants, 21.9% reported using rehabilitation care in the year before the interview. Of those, 60.1% were 70-80 years-old, 61.4% were female, and 83.4% were non-Hispanic white (83.4% versus 6.2% non-Hispanic black, 5.5% Hispanic, and 2.4% Asian). The mean [SD] physical performance score was 3.93 [0.11] on a 12-point scale with higher points indicating better function. Primary reasons for rehabilitation were post-surgery recovery (30.2%) and non-surgical musculoskeletal conditions (42.6%). Overall, rehabilitation use increased during the study period from 20.7% in 2015 to 24.3% in 2022, with a dip in 2020 (20.5%). Inpatient and home-based rehabilitation use declined over time (from 34.2% to 24.1% and from 39.0% to 34.9%, respectively), while outpatient rehabilitation use rose from 62.5% to 73.3%. The percentage of respondents reporting functional improvement increased from 69.7% in 2015 to 72.3% in 2022, with 56.4% endorsing significant improvement.

Conclusions: From 2015-2022, use of rehabilitation services among older adults increased, especially for outpatient services. Patient-reported functional improvement also increased over time with the majority reporting a high level of improvement. These trends lend support to the value of community-based rehabilitation services in improving overall function for older adults with disabilities.