Hip fracture and the influence of dementia on health outcomes and access to hospital-based rehabilitation for older individuals

Abstract

Background: For older individuals who sustain a hip fracture, the presence of dementia can influence their access to hospital-based rehabilitation.

Purpose: This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and access to, and outcomes following, hospital-based rehabilitation in a population-based cohort.

Method: An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospitalisation, rehabilitation and mortality records during 2009–2013.

Results: There were 8785 individuals with and 23 520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-d mortality rate compared to individuals without dementia (11.7% versus 5.7%), a lower proportion of age-adjusted 28-d re-admission (17.3% versus 24.4%) and a longer age-adjusted mean length of stay (22.2 versus 21.9 d). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90–4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than individuals without dementia.

Conclusion: Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility.

Implications for Rehabilitation

• Older individuals with dementia can benefit from rehabilitation activities following a hip fracture.

• Early mobilisation of individuals post-hip fracture surgery, where possible, is advised.

• Further work is needed on how best to work with individuals with dementia after a hip fracture in residential aged care to maximise any potential functional gains.

Keywords:

• Dementia
• hip fracture
• hospitalisation
• older adults

Acknowledgements

The authors wish to thank the NSW Ministry of Health and the Activity Based Funding Taskforce for providing access to the APDC and the SNAP data collection, the NSW Registry of Births Deaths and Marriages for providing access to mortality data and the CHeReL for conducting the record linkage.

Declaration of interest

This research was funded by the Dementia Research Collaborative Centre – Assessment and Better Care, UNSW.