Scoping review exploring the impact of hip fracture in older adults with cognitive impairment or dementia

Abstract

Objectives: This review summarises the impact of hip fractures on health outcomes including subsequent falls, hospitalisation, length of hospital stay (LOS), functional status, quality of life and mortality in older adults with cognitive impairment or dementia. It also explores the risk of institutionalisation following a hip fracture in this population.

Design: A scoping review following the Arksey and O'Malley framework guided by the Joanna Briggs Institute methodology and adheres to Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews guidelines.

Data sources: A comprehensive search strategy was developed to search MEDLINE, EMBASE, CINAHL and grey literature, with additional references identified through citation searching and Web of Science.

Eligibility criteria: Studies were included if they examined older adults with cognitive impairment or dementia who experienced a hip fracture and reported outcomes related to hospitalisation, functional status, quality of life, mortality or institutionalisation.

Data extraction and synthesis: Study selection and data extraction were conducted independently by two reviewers using Covidence software. A narrative synthesis approach was employed to summarise findings and identify key themes, patterns and gaps in the literature.

Results: We identified 30 studies reporting health outcomes following hip fracture. Overall, the studies indicated that individuals with cognitive impairment or dementia have higher hospitalisation rates, poorer walking ability and functional outcomes, as well as reduced quality of life posthip fracture. The LOS for individuals with dementia following hip fracture was inconsistent across studies, with some reporting shorter LOS and others indicating longer LOS. Individuals with dementia consistently exhibit higher mortality rates at 30 days, 90 days and 1-year postfracture compared with those without dementia. We found 21 studies that evaluated the risk of institutionalisation following a hip fracture. Older adults with dementia were significantly more likely to be institutionalised posthip fracture, with nearly five times the risk of failing to return home compared with those without dementia. This increased risk persists up to 1-year postfracture and is particularly pronounced in those with severe cognitive impairment, with higher rates of nursing home placement observed among individuals with hip fractures.

Conclusion: Older adults with cognitive impairment or dementia experience significantly worse outcomes following hip fractures, including higher mortality, poorer functional outcomes, reduced quality of life and a higher risk of institutionalisation postfracture. Future research should focus on developing effective strategies for fracture prevention, including optimising osteoporosis treatment in this high-risk population, and developing targeted interventions to improve the impact of fractures on functional outcomes and reduce institutionalisation rates in this vulnerable population.

Keywords: aging; cognition; dementia; fractures, bone.

Figure 1. Flow diagram of included studies on outcomes following a hip fracture in older adults with cognitive impairment or dementia. BMD, bone mineral density; RCT, randomised controlled trial.

Figure 2. Flow diagram of included studies evaluating the risk of institutionalisation following a hip fracture in individuals with cognitive impairment or dementia. RCT, randomised controlled trial, RQ1 research question 1