Rehabilitation in nursing homes: a cross-national comparison of recipients

Objective: to examine the prevalence of therapy use in nursing homes in selected countries and to describe the characteristics of nursing home residents who receive therapy. Design and sampling: the design of the study is cross-sectional, using Minimum Data Set (MDS) assessments of nursing home residents. The sample includes all nursing home residents in six US states (n = 273 491), in Copenhagen, Denmark (n = 3451), Reyjkavik, Iceland (n = 1254), and selected locations in Italy (n = 1089) and Japan (n = 1255). Method: we determined who had received physical or occupational therapy treatments in the last 7 days. Demographic and clinical characteristics of recipients were compared relative to other nursing home residents within each country. Results: in the five countries, the prevalence of receiving therapy was 31% (Iceland), 30% (Japan), 23% (Denmark), 14% (Italy) and 11% (USA). Substantial proportions of the recipients were over the age of 85, were clinically stable and had been in the nursing home for longer than 90 days. Across all countries, residents with poorer activities of daily living (ADL) scores but good cognitive scores were more likely to receive therapy than other residents. Rehabilitation nursing, an adjunct to therapy, was concentrated on residents with poor ADL scores. Conclusions: substantial numbers of long-stay residents receive therapy in nursing homes, including those over the age of 85 years and those with cognitive impairment. Hence, future rehabilitation outcome studies can involve these previously understudied patient populations.