Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review

Abstract

Purpose: Best rehabilitation practices after hip fracture for people with dementia have not been established. A systematic review was conducted to determine current evidence for rehabilitation in this population, including residents in continuing care. Methods: Standardized review methodology was used to search eight databases for literature on hip-fracture rehabilitation for people with dementia. Eligible studies included participants with dementia who had a hip fracture; performed a rehabilitation intervention; and evaluated one or more of function, ambulation, discharge location, or falls. The Newcastle-Ottawa Scale was used to assess validity. Results: A total of 13 studies were included: five randomized controlled trials (RCTs), seven prospective cohort series, and one retrospective cohort study. Average quality ratings for RCTs and cohort studies were good and fair respectively. Participants with mild to moderate dementia receiving rehabilitation showed similar relative gains in function to those without dementia. Only one study examined the effect of rehabilitation among residents in continuing care. Conclusions: People with mild or moderate dementia may show improved function and ambulation and decreased fall risk after rehabilitation post hip fracture, similar to gains achieved by those without dementia. More research is required to ascertain the effect of rehabilitation in people with moderate to severe dementia, including those residing in continuing-care settings.Key Words: dementia; geriatrics; hip fractures; rehabilitation. RÉ SUMÉObjectif : Il n'y a pas de pratiques exemplaires d'é tablies pour la ré adaptation aprè s une fracture de la hanche chez les personnes aux prises avec la dé mence. Nous avons procé dé à une revue systé matique en vue de recueillir les faits cliniques relatifs à la ré adaptation chez ce segment de la population, y compris les personnes en soins prolongé s. Mé thode : Une mé thodologie d'examen de documents normalisé e a é té utilisé e pour effectuer une recherche dans huit bases de donné es afin de recueillir de la documentation sur la ré adaptation aprè s une fracture de la hanche chez les personnes souffrant de dé mence. Les é tudes admissibles traitaient de patients avec dé mence qui avaient subi une fracture de la hanche; auprè s de qui on avait procé dé à une intervention en ré adaptation; et où au moins une fonction, la marche, le site du congé ou les risques de chutes avaient é té é valué s. L'é chelle de Newcastle-Ottawa a é té utilisé e aux fins d'é valuation de la validité de ces é tudes. Ré sultats : Au total, 13 é tudes ont é té ré pertorié es; cinq essais contrô lé s randomisé s (ECR), sept é tudes de cohorte prospective et une é tude de cohorte ré trospective. La qualité moyenne des ECR et des é tudes de cohortes é taient respectivement bonne à moyenne. Les participants avec dé mence lé gè re à modé ré e qui recevaient des traitements de ré adaptation ont dé montré des gains relatifs de fonction similaires à ceux qui ne souffraient pas de dé mence. Un...

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

“…It also addressed some of the gaps in hip fracture rehabilitation, such as the lack of interventions that enhance self-efficacy 24,169,242,243 and address postural balance and fear of falling, 14,21,24,169 the exclusion of moderately cognitively impaired patients, 10,16,17,24,36,57,244 the short-term provision of rehabilitation services 10,244 and the lack of reporting of carer outcomes. 10 Self-efficacy to exercise has long been recognised as an important mediator for regaining confidence in daily activities and function and overcoming the fear of falling, to enable an increase in the practice of physical activities and exercise.…”

“…7 However, a systematic review of rehabilitation in patients with dementia following hip fracture found that those with mild to moderate dementia showed similar relative gains in function to those without dementia. 17 In addition, hip fracture patients with cognitive impairment are at increased risk of delirium, medical complications, death, prolonged stay and loss of independence. According to the NICE guidelines on delirium, 18 patients with memory problems are known to benefit from comprehensive geriatric assessment and targeted intervention to reduce the risk of delirium.…”

“…The reviews identified 3,5,9,10,14,17,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] and their reference lists were the starting point for identifying both…”

A Guide to Improving the Care of Patients with Fragility Fractures, Edition 2

“…198,199 Rehabilitation programs have been shown to be effective in the patient with dementia although the best approach is currently unknown. 200 The length and intensity of rehabilitation after hip fracture is a topic of great importance. Studies have shown that long periods of rehabilitation improve function.…”

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

“…6 Recent studies provide conflicting evidence regarding the factors that influence recovery in older adults with hip fracture after discharge from inpatient rehabilitation. Factors such as prefracture cognitive and functional status, 7,8 cognitive impairment, [9][10][11][12][13][14][15][16] age, 17 sex, [18][19][20] medical co morbidities, 21 and pain 22 have been found to influence recovery, function, and mobility outcomes over time in older adults after hip fracture, 12,[14][15][16] yet two systematic reviews indicated that individuals with cognitive impairment made gains that were similar to those of individuals without cognitive impairment. 16,23 Albeit informative, these studies were unclear as to how many individuals with complex needs were offered active rehabilitation, the type and approaches used during rehabilitation, and the extent to which inpatient care influenced long-term outcomes.…”