Rehabilitation of Older Adults with Dementia After Hip Fracture

• Published in: Journal of the American Geriatrics Society (JAGS) 2016-01, Vol.64 (1), p.47-54
• Main Authors: Seitz, Dallas P., Gill, Sudeep S., Austin, Peter C., Bell, Chaim M., Anderson, Geoffrey M., Gruneir, Andrea, Rochon, Paula A.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Dementia; Dementia - complications; Dementia - mortality; Dementia - rehabilitation; Female; Follow-Up Studies; Fracture Fixation; Fractures; Geriatrics; health services; hip fracture; Hip Fractures - complications; Hip Fractures - rehabilitation; Hip Fractures - surgery; Hip joint; Humans; Male; nursing home placement; Ontario - epidemiology; Postoperative Care - methods; Rehabilitation; Retrospective Studies; Survival Rate; Treatment Outcome
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.13881

Objectives To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture. Design Retrospective cohort study. Setting Ontario, Canada. Participants Community‐dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home‐care based rehabilitation (HCR), and inpatient rehabilitation (IPR). Measurements Time to long‐term care (LTC) placement, mortality, and risk of repeat hip fracture and falls. Results Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P = .03); there were no other significant between‐group differences in risk of falls or repeat fractures (P > .05). Conclusion Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.