Aims
Rehabilitation is essential for reducing disability and supporting functional recovery, yet access remains inequitable for some groups. This study examined trends and disparities in rehabilitation utilisation after hip fracture or stroke among older adults with and without dementia.
Methods
Using linked data from the national Registry of Senior Australians (2014–2019), we compared rehabilitation utilisation following hip fracture or stroke among individuals aged 65+ receiving either residential aged care (RACH) or community‑based Home Care Packages (HCPs) in New South Wales, Victoria and Queensland. Rates were examined over time and stratified by dementia status.
Results
Among 9647 individuals (2504 with dementia; 7143 without), 64% had a hip fracture and 36% a stroke. In the HCP cohort, rehabilitation utilisation after hip fracture increased for people without dementia (56.5% to 60.7%) but declined for those with dementia (53.6% to 44.0%). A similar pattern was observed after stroke, with rising utilisation among people without dementia (44.0% to 47.4%) and decreasing utilisation among those with dementia (32.1% to 26.5%). In RACHs, rehabilitation after hip fracture declined for both groups, remaining substantially lower for people with dementia. For stroke in RACHs, utilisation increased slightly for both groups but remained low overall, particularly for people with dementia.
Conclusions
Rehabilitation utilisation declined over time among community‑dwelling people with dementia but increased among those without dementia, widening existing disparities. Consistently lower utilisation for people with dementia across settings highlights systemic barriers to equitable access. Integrating rehabilitation into dementia‑specific care pathways is urgently needed to address these persistent gaps.