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

Smith, Toby; Hameed, Yasir; Cross, Jane; Henderson, Catherine; Sahota, Opinder; Fox, Chris

doi:10.1002/14651858.cd010569.pub2

Cited by 55 publications

(53 citation statements)

References 77 publications

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“…There has been only one systematic review, a Cochrane review, published on rehabilitation care for individuals with dementia following hip fracture surgery 10 . The Cochrane review focused only on randomized and quasi-experimental controlled trials and considered the effectiveness of the care on individual and system related outcomes.…”

Section: Introductionmentioning

confidence: 99%

Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review

Resnick

Beaupré

McGilton

et al. 2016

Journal of the American Medical Directors Association

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Purpose Currently, most rehabilitation services for individuals who sustain a hip fracture are not designed to meet the complex needs of those who also have cognitive impairment. The goal of this review was to identify current best practices for rehabilitation in long term care settings and approaches to optimize outcomes among individuals with dementia and other cognitive impairments post hip fracture. Procedures The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (the PRISMA Statement) was used to guide the review. Five electronic databases, including Pubmed, EMBASE, CINAHL (EBSCO), Medline (EBSCO) and PsycINFO (EBSCO), were searched for intervention studies published in English language journals. Studies were eligible if they focused on rehabilitation interventions post hip fracture among older individuals (≥ 65 years) with cognitive impairment who were living in or transferred to long-term care or post-acute/rehabilitation settings post hip fracture. Studies were excluded if they did not enroll individuals with cognitive impairment, the study was descriptive without any intervention content, or the intervention components were only medication, surgical approach or medical treatment. Main Findings A total of 4,478 records were identified, 1915 of which were duplicative, 2,563 were relevant based on title and after careful review seven studies were included. Two included studies were randomized controlled trials, one was a single group pre- and post-test, one a descriptive comparison between those with and without cognitive impairment, one a case controlled matched trial, one a nonequivalent groups trial, and one a case report. The interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals. Conclusions The evidence summarized in this review suggests that it is feasible to implement rehabilitation programs focused on individuals with cognitive impairment in post-acute care settings. Moreover, there was evidence to suggest that intensive rehabilitation and exercise activities are beneficial, although innovative approaches may be needed to engage individuals with cognitive impairment.

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Section: Introductionmentioning

confidence: 99%

Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review

Resnick

Beaupré

McGilton

et al. 2016

Journal of the American Medical Directors Association

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“…[34][35][36][37][38] Without measures of quality of care in the postacute period for patients with hip fracture, frontline staff, administrators and policymakers are left without required information to assess the delivery of care during the postsurgical rehabilitation period. 39 40 The objective of this study is to synthesise the evidence on existing or potential quality of care indicators for the acute period, the postacute period and across the entire continuum of care for patients following a hip fracture.…”

Section: Introductionmentioning

confidence: 99%

Scoping review of potential quality indicators for hip fracture patient care

et al. 2017

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ObjectiveThe purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture.DesignScoping review.SettingAll care settings.Search strategyEnglish peer-reviewed studies published from January 2000 to January 2016 were included. Literature search strategies were developed, and the search was peer-reviewed. Two reviewers independently piloted all forms, and all articles were screened in duplicate.ResultsThe search yielded 2729 unique articles, of which 302 articles were included (11.1%). When indicators (eg, in-hospital mortality, acute care length of stay) and potential indicators (eg, comorbidities developed in hospital, walking ability) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures (process). There was heterogeneity in definitions within constructs between studies. There was also a paucity of indicators and potential indicators in the postacute period.ConclusionsTo improve quality of care for patients with hip fracture and create a more efficient healthcare system, mechanisms for the measurement of quality of care across the entire continuum, not just during the acute period, are required. Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the postacute period.

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“…97 A recent Cochrane systematic review included conflicting results on this topic, which highlights the importance of missing evidence to allow for definitive conclusions. 98 It is important to emphasize that elderly patients' capacity to follow instructions relating to weight-bearing restrictions is likely to be altered, especially if cognitive impairment is present. Therefore, the decision-making process that is involved in choosing the type of surgery to perform should take into account that weight bearing should be permitted as tolerated.…”

Section: Rehabilitationmentioning

confidence: 99%

Hip Fracture in the Elderly

Urrutia¹,

Zamora²,

Klaber³

2017

CMGer

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Hip fractures in elderly patients are the most severe form of fragility fractures. They can lead to significant morbidity and mortality; additionally, they have an enormous economic and social burden. Treatment of hip fractures in elderly patients should be based on a prompt initial evaluation, followed by surgical treatment without unnecessary delays under a collaborative effort of a multidisciplinary team. Postoperative care should be started immediately after surgery, and it must include an intensive rehabilitation, as well as treatment of osteoporosis and any other metabolic imbalance. This review incorporates current literature on initial evaluation and definitive management of hip fractures in the elderly and is intended to assist practitioners of different specialties treating these patients.

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

Abstract: Analysis 1.4. Comparison 1 Interdisciplinary geriatric rehabilitation (inpatient and community rehabilitation) versus conventional rehabilitation, Outcome 4 Number of participants in institutionalised care (hospital or nursing home) at 12 months post-hip fracture.

Cited by 55 publications

References 77 publications

Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review

Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review

Scoping review of potential quality indicators for hip fracture patient care

Hip Fracture in the Elderly

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