The Association Between Communication Impairments and Strategies and the Receipt of Physical and Occupational Therapy for Long-Term Care Residents With Dementia: A Cross-Sectional Study

Purpose: This study aims to examine the association between communication impairments and strategies with the receipt of physiotherapy (PT) and occupational therapy (OT) in long-term care (LTC) residents with dementia. Method: LTC residents with dementia from Ontario, Canada, who were assessed by the Resident Assessment Instrument 2.0 between 2015 and 2019 were included in a cross-sectional analysis of secondary data. Adjusted odds ratios and 95% confidence intervals were obtained from a series of multivariable logistic regressions for each individual communication variable with the PT and OT variables. Results: We included 79,769 Ontario LTC residents with dementia, where 98% were over the age of 65 years and 70% were female. Residents with dementia were less likely (Cohen's d ) to receive PT if they had impaired hearing (−0.07), had an impaired ability to make oneself understood (−0.17), or had an impaired ability to understand others (−0.21). Conversely, residents with dementia were more likely to receive PT with communication strategies in place, including using a hearing aid (0.19), other receptive communication techniques (e.g., lipreading, physical contact, LTC staff writing messages; 0.10), or other modes of expression (e.g., flash cards and electronic devices; 0.13). In contrast, residents with dementia and impaired ability to be understood (0.26), to understand others (0.40), to speak clearly (0.15), or to use speech (0.15) were more likely to receive OT. Conclusions: Residents with dementia and communication impairments were less likely to receive PT but were more likely to receive OT. When strategies to aid communication were used, residents with dementia were more likely to receive PT. Our work highlights important communication barriers and potential facilitators that must be analyzed to ensure equitable access to rehabilitation in LTC.