Associations between hospital-based rehabilitation for hip fracture and two-year outcomes for mortality and independent living: An Australian database study of 1,724 elderly community-dwelling patients

Abstract

In-hospital rehabilitation substantially increases total hospital costs. It is associated with improved early and late survival, but not with the likelihood of living independently for up to 2 years after hip fracture.

Cognitive Status and Outcomes of Older People in Orthopedic Rehabilitation? A Retrospective-Cohort Study

“…This also indicates that these patient had better functional outcomes, with similar cognitive abilities to those admitted for elective surgery. As has been noted in other studies patients admitted with fractures due to falls, commonly have declining function prior to admission [6,21] which influences functional outcomes, but may also provide more opportunity for improvement. Additionally, patients admitted for elective surgery may be better prepared prior to admission with social supports, home set-up and completing pre-admission exercises, and thus have a higher starting point of function, with less improvements measurable at the end of a rehabilitation program.…”

“…The assessment is easy to administer with 18 questions broken down into the areas of visuospatial/executive, naming, memory, attention, language, abstraction, delayed recall, and orientation. The total score is out of 30, with scores being broken down into the following severity levels: intact (26-30), mild cognitive impairment (18)(19)(20)(21)(22)(23)(24)(25), moderate cognitive impairment (10)(11)(12)(13)(14)(15)(16)(17), and severe impairment (9 or less). The occupational therapist completing the assessments was trained to use the MoCA.…”

Older people with hip fracture transferred to intermediate care: outcomes in an integrated health and social care model

“…However, that particular study looked at patients in hospital-based IMC which may account for differences in findings. 20 We postulate that the readmission rate is higher in the IMC group as they are a self-selecting group of frailer, more vulnerable adults than those who are in a position to be discharged home directly from hospital.…”

Use of databases and registries to understand post-operative hip fracture management

“…Ireland et al's (1) interesting study reveals the untapped potential of linking clinical registries and administrative databases. The authors analysed the Department of Veterans' Affairs (DVA) database of communitydwelling patients to compare rates of mortality, hospital readmission and independent living status following hip fracture with and without hospital-based rehabilitation (1). The 3 key findings of this study were:…”

“…Ireland et al's study does not explain the extent to which patient selection for hospital rehabilitation biased the outcome for mortality. "The assessment of 'potential to benefit', which is integral to the process of selection for transfer into rehabilitation (REH) appears to identify factors associated with better survival" (1). Similarly, the authors were not able to determine the reasons why there was no change in the likelihood of living independently up to 2 years after hip fracture.…”