Rehabilitation of older adults with dementia after hip fracture

Background — Older adults with dementia frequently experience hip fractures. Rehabilitation following surgery is important in order to reduce functional decline. There are few large-scale studies examining the effects of rehabilitation on postoperative outcomes of older adults with dementia.

Objective — To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fractures.

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 fractures and falls.

Results — A total of 11,200 individuals with dementia experienced hip fractures during the study period. Of the total group, 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. As compared to no rehabilitation, HCR and IPR were each associated with a reduced risk of LTC admission following discharge from hospital. When compared to no rehabilitation, all three forms of rehabilitation were associated with reduced risks of mortality, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls compared to no rehabilitation (P=0.03) while there were no other significant differences noted in either risk of falls or repeat fractures between groups (P>0.05).

Conclusions — Post-fracture rehabilitation for older adults with dementia is associated with a reduced risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve post-fracture outcomes.