Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

Abstract

Objectives: To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture.

Design: Longitudinal.

Setting: Inpatient rehabilitation units of two community hospitals.

Participants: Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133).

Measurements: Mini-Mental State Examination (MMSE) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self-Care Function and Functional Mobility) and the New Mobility Scale (NMS). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge.

Results: Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment (PCRM-CI) intervention group had higher NMS scores after discharge than a usual care group.

Conclusion: Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.

Keywords: cognitive impairment; dementia, rehabilitation models of care; hip fracture; long-term rehabilitation outcomes; person-centered models of care.

Figure 1

Patient Centered Rehabilitation Model‐Cognitive Impairment model of care (PCRM‐CI) participant study flow diagram.

Figure 2

Change in outcomes from admission through 6 months after discharge for each category of cognitive impairment. Black markers present unadjusted values and show the contribution of cognitive impairment and prefracture functional impairment. White markers depict the adjusted changes (removed effect of prefracture functional impairment) to illustrate the influence of cognitive impairment alone. FIMS = Functional Independence Measure Self‐care Subscale; FIMM = Functional Independence Measure Mobility Subscale; NMS = New Mobility Scale.