Factors determining eligibility and access to subacute rehabilitation for elderly people with dementia and hip fracture

Abstract

With hip fracture and dementia increasing in incidence in the global ageing population, there is a need for the development of specific procedures targeting optimal treatment outcomes for these patients. This paper looks primarily at the factors that limit access to subacute rehabilitation services as a growing body of evidence suggests that access to timely inpatient rehabilitation increases functional outcomes for patients both with dementia and without. Information was gathered by searching electronic data bases (SCOPUS, Medline, CINAHL, Health Source Nursing/Academic Addition, Psychinfo and the Cochrane Library) for relevant articles using the search terms dementia OR Alzheimer* AND hip fracture AND subacute rehabilitation OR convalescence for the period 2005–2015. Abstracts were scanned to identify articles discussing eligibility and access. A total of nine papers were identified that directly addressed this topic. Other papers discussing success or failure of rehabilitation and improved models of care were also reviewed. Barriers to access discussed in the literature include information management, management of comorbidities, attitudes, resource availability, and the quality of evidence and education. By identifying these factors we can identify strategic points of intervention across the trajectory of prevention, treatment and rehabilitation that may improve outcomes for this growing group of vulnerable patients. Emerging best practice for these patients is also discussed.

The Effect of an In-Hospital Comprehensive Geriatric Assessment on Short-Term Mortality During Orthogeriatric Hip Fracture Program—Which Patients Benefit the Most?

“…In a subgroup analysis of hip fracture patients with dementia, the intervention group experienced fewer complications and better functional recovery, but the multidisciplinary intervention program had no effect on mortality. 26 Poor knowledge of the engagement and recovery capacity of patients with dementia affects their access to rehabilitation after hip fracture, 27 and this may also impact acute care decisions. A geriatric approach includes individual consideration for each patient and no denial of treatment or rehabilitation based merely on a diagnosis of dementia.…”

A comprehensive approach to reablement in dementia

“…However, in practice, it is often assumed that older individuals with cognitive impairment will not be able to participate in rehabilitation programs and/or demonstrate progress, and thus, they are generally admitted to programs with lower intensity rehabilitation or are ineligible for admission to rehabilitation settings [43] . This nihilistic belief that a diagnosis of dementia makes the person unable to participate effectively and benefit from a rehabilitation program can lead to reluctance on the part of health care practitioners and administrators to devote scarce resources to patients who are cognitively impaired, no matter where they reside [48] .…”

Ultrasound‐guided femoral nerve blocks are not superior to ultrasound‐guided fascia iliaca blocks for fractured neck of femur

“…Estimates indicate approximately 19 000 people are hospitalised with a hip fracture in Australia each year . Increases in the number of hip fractures have been observed globally and are associated with longer life expectancies and an ageing population . Neck of femur and proximal femoral fractures predominantly occur in people over the age of 65, with a higher occurrence in older women .…”

“…1 Increases in the number of hip fractures have been observed globally and are associated with longer life expectancies and an ageing population. 2,3 Neck of femur and proximal femoral fractures predominantly occur in people over the age of 65, 1 with a higher occurrence in older women. 4 The presence of dementia is a significant issue in patients with hip fractures with 30-45% of this population having a diagnosis of dementia.…”