Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia

Abstract

Objective To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture. Design Preplanned subanalysis of randomised intervention study. Settting Jyväskylä Central Hospital, Finland. Participants 243 independently living patients aged 65 years or older admitted to hospital with hip fracture. Intervention After surgery patients in the intervention group (n = 120) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals. Main outcome measures Length of hospital stay, mortality, and place of residence three months and one year after surgery for hip fracture. Results The median length of hospital stay of hip fracture patients with moderate dementia (mini mental state examination score 12-17) was 47 days in the intervention group (n = 24) and 147 days in the control group (n = 12, P = 0.04). The corresponding figures for patients with mild dementia (score 18-23) were 29 days in the intervention group (n = 35) and 46.5 days in the control group (n = 42, P = 0.002). Three months after the operation, in the intervention group 91% (32) of the patients with mild dementia and 63% (15) of the patients with moderate dementia were living independently. In the control group, the corresponding figures were 67% (28) and 17% (2). There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores. Conclusions Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation.

Primary hemiarthroplasty in old patients with displaced femoral neck fracture

“…As orthopedic surgeons, we control rehabilitation in the orthopedic department, but we do not know what will happen to the patients when they leave the hospital. Many authors have reported that active geriatric rehabilitation is effective and reduces costs (Clayer and Bauze 1989, Borgquist et al 1991, Farnworth et al 1994, Huusko et al 2000. If we implant an expensive arthroplasty, it is essential that effective rehabilitation is also given in nursing homes and old people's homes.…”

Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

“…46 Other features of the interventions described included early participation in self-care 43 and practising activities throughout the day with nurses. 42 …”

“…Three interventions included PT sessions carried out twice daily 5 days a week. 22,42,43 Interventions specific to PT included strengthening and range-of-motion exercises and instruction to patients in gait and transfer training. 45 Early mobilization within the first 24 hours following surgery was included in two studies.…”

“…Specialized interventions involved combinations of geriatrician internists, general practitioners, nurses, social workers, neuropsychologists, and occupational, physical, and speech therapists. [41][42][43][44] Patients involved in specialized interventions participated in PT and OT at varying levels of intensity, frequencies, and durations. Three interventions included PT sessions carried out twice daily 5 days a week.…”

Management of Subtrochanteric Fractures with Long PFN: Union Rates and Functional Results

“…Previous studies indicate that patients with impaired cognitive function have an increased risk for general as well as fracture-related complications 20 , problems in assimilating rehabilitation 21 , prolonged hospital stay, poor long-term outcome and an increased mortality rate 22 . Our study was consistent with these findings.…”