Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery

Abstract

Background Hip fracture is a major injury that causes significant problems for a ected individuals and their family and carers. Over 40% of people with hip fracture have dementia or cognitive impairment. The outcomes of these individuals a er surgery are poorer than for those without dementia. It is unclear which care and rehabilitation interventions achieve the best outcomes for these people. This is an update of a Cochrane Review first published in 2013. Objectives (a) To assess the e ectiveness of models of care including enhanced rehabilitation strategies designed specifically for people with dementia following hip fracture surgery compared to usual care. (b) To assess for people with dementia the e ectiveness of models of care including enhanced rehabilitation strategies that are designed for all older people, regardless of cognitive status, following hip fracture surgery, compared to usual care. Search methods We searched ALOIS (www.medicine.ox.ac.uk/alois), the Cochrane Dementia and Cognitive Improvement Group Specialised Register, MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCOhost), Web of Science Core Collection (ISI Web of Science), LILACS (BIREME), ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform on 16 October 2019. Selection criteria We included randomised and quasi-randomised controlled trials evaluating the e ectiveness of any model of enhanced care and rehabilitation for people with dementia a er hip fracture surgery compared to usual care. Data collection and analysis Two review authors independently selected trials for inclusion and extracted data. We assessed risk of bias of the included trials. We synthesised data only if we considered the trials to be su iciently homogeneous in terms of participants, interventions, and outcomes. We used the GRADE approach to rate the overall certainty of evidence for each outcome. Enhanced rehabilitation and care models for adults with dementia following hip fracture surgery (Review)

<p>Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia – A Subgroup Analysis of a Randomized Controlled Trial</p>

“…1 An individual with Alzheimer´s disease is about three times more likely to sustain a hip fracture than an age-and sex-matched control who is cognitively intact, 2 and the outcomes are worse when compared with people without dementia. Mortality is higher, [2][3][4][5] postoperative complications are more common, 3,6 and the negative impact on mobility and performance in activities of daily living (ADL) is greater in people with dementia than in people who are cognitively intact. [5][6][7] In addition, dementia is an independent risk factor for postoperative admission to longterm residential care.…”

“…Mortality is higher, [2][3][4][5] postoperative complications are more common, 3,6 and the negative impact on mobility and performance in activities of daily living (ADL) is greater in people with dementia than in people who are cognitively intact. [5][6][7] In addition, dementia is an independent risk factor for postoperative admission to longterm residential care. 3 Despite dementia being common among older people with hip fracture and that the population has complex care needs, 6 the condition has often been an exclusion criterion for participation in previous clinical trials.…”

“…[5][6][7] In addition, dementia is an independent risk factor for postoperative admission to longterm residential care. 3 Despite dementia being common among older people with hip fracture and that the population has complex care needs, 6 the condition has often been an exclusion criterion for participation in previous clinical trials. 8 There is, however, growing evidence that people with hip fracture and cognitive impairment (CI) or dementia benefit from enhanced interdisciplinary rehabilitation in hospital, 9,10 combined in-hospital and in-home rehabilitation, [11][12][13][14] and from rehabilitation in nursing homes, 15 although the optimal rehabilitation strategies remain unclear.…”

“…8 There is, however, growing evidence that people with hip fracture and cognitive impairment (CI) or dementia benefit from enhanced interdisciplinary rehabilitation in hospital, 9,10 combined in-hospital and in-home rehabilitation, [11][12][13][14] and from rehabilitation in nursing homes, 15 although the optimal rehabilitation strategies remain unclear. 6 To our knowledge, no previous team-based home rehabilitation (HR) interventions after hip fracture have included people with severe CI or dementia. We have, however, in a randomized controlled trial (RCT) evaluated a Geriatric Interdisciplinary Home Rehabilitation (GIHR) intervention for older people with hip fracture, including those with dementia and those living in residential care facilities, compared with in-hospital geriatric care according to a multifactorial rehabilitation program.…”

People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway

“…This lack of information makes the development of practice guidelines difficult. While there is evidence suggesting that rehabilitation following hip fracture repair improves outcomes and that this rehabilitation is best provided as part of an organised multidisciplinary health care team it is unclear how services should be provided to people living in NCFs, the majority of whom have dementia [2,3]. There are, as yet, few protocols to guide treating therapists who work with residents living in NCFs after their return home.…”