Rehabilitation of Older Adults with Dementia After Hip Fracture

Abstract

Objectives: To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture.

Design: Retrospective cohort study.

Setting: Ontario, Canada.

Participants: Community-dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home-care based rehabilitation (HCR), and inpatient rehabilitation (IPR).

Measurements: Time to long-term care (LTC) placement, mortality, and risk of repeat hip fracture and falls.

Results: Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P=.03); there were no other significant between-group differences in risk of falls or repeat fractures (P>.05).

Conclusion: Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.

Keywords: dementia; health services; hip fracture; nursing home placement; rehabilitation.