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

Abstract

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.

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

“…22 The benefit of rehabilitation in this group has been studied; one study evaluating rehabilitation in patients with dementia following hip fracture found that both inpatient and home-based rehabilitation were associated with lower mortality risk and lower likelihood of admission to 24-hour care 11 and several studies have demonstrated functional benefit from rehabilitation in this group. [12][13][14] The small sample size of this study prevents accurate interpretation of mortality differences in particular.…”

“…[7][8][9][10] Notwithstanding this, this cohort has been shown to be less likely to access rehabilitation following hip fracture. [11][12][13][14] Delirium occurs in 35-65% of patients admitted with hip fracture. 15 Patients with delirium in the perioperative period have also been shown to have poorer functional recovery, higher rates of institutionalisation and higher mortality rates.…”

The Hopkins Rehabilitation Engagement Rating Scale – Reablement Version (HRERS‐RV): Development and psychometric properties

“…One of the aims of the study was to identify and explore individual and service characteristics associated with intervention outcomes. Existing evidence from rehabilitation (Bright et al, ; Hochhalter, Song, Rush, Sklar, & Stevens, ; Resnick et al, ), and qualitative evidence from previous studies of reablement (Hjelle et al, ), indicated that it would be valuable and important to investigate the impact of engagement on outcomes. Thus, we developed the HRERS‐RV and included in the suite of measures used by the study, with the proviso that HRERS‐RV data would only be used if psychometric tests deemed it acceptable.…”

“…One of the aims of the study was to identify and explore individual and service characteristics associated with intervention outcomes. Existing evidence from rehabilitation (Bright et al, 2015;Hochhalter, Song, Rush, Sklar, & Stevens, 2010;Resnick et al, 2016), and qualitative evidence from previous studies of reablement (Hjelle et al, 2017), integrity of the HRERS in the revised version and therefore retained it. Interestingly, this item proved the most difficult item to adapt to the reablement context; further work on the wording of this item may address this issue.…”

Rehabilitation of persons with dementia: using technology to improve participation

“…Rehabilitation with PwDs, however, can be challenging. Research on rehabilitation has found that PwDs can improve in functional abilities (Muir & Yohannes, 2009;Resnick et al, 2016), but they generally have poorer outcomes than persons without dementia (Poynter, Kwan, Sayer, & Vassallo, 2011;S€ oderqvist, Miedel, Pozner, & Tidermark, 2006). Inability of PwDs to engage fully in treatment has been identified as a possible reason for poorer responses (Paolucci et al 2012).…”