Rehabilitation interventions for persons with hip fracture and cognitive impairment: A scoping review

Abstract

Background Hip fractures are common fall-related injuries, with rehabilitation and recovery often complicated by cognitive impairment. Understanding what interventions exist, and in what settings, for people with hip fracture and co-occurring cognitive impairment is important in order to provide more evidence on rehabilitation and related outcomes for this population. Objective To examine the extent, nature, and range of literature on rehabilitation interventions for adults with hip fracture and cognitive impairment. Methods Articles were required to: include an adult population with hip fracture and cognitive impairment, include a rehabilitation intervention, and be published between January 1, 2000 and November 19, 2021. Articles were excluded if they were opinion pieces, study protocols, conference abstracts, or if they did not describe the rehabilitation intervention. Relevant articles were searched on the following electronic databases: MEDLINE, EMBASE, CINAHL Plus, APA PsycINFO, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database. All articles were double-screened by two reviewers and disagreements were resolved through consensus. Data were extracted and synthesized using descriptive approaches. Results Seventeen articles were included in this scoping review. We identified a variety of interventions targeting this population; about half were specific to physical rehabilitation, with the other half incorporating components that addressed multiple aspects of the care journey. Interventions had varying outcomes and no studies qualitatively explored patient or family experiences. All intervations were initiated in hospital, with less than half including cross-sectoral components. About half of the articles described modifying or tailoring the intervention to the participants’ needs, but there was limited information on how to adapt rehabilitation interventions for individuals with cognitive impairment. Conclusions More work is need to better understand patient, family, and provider experiences with rehabilitation interventions, how to tailor interventions for those with cognitive impairment, and how to successfully implement sustainable interventions across sectors.

Exploring Factors Associated With Resilience and Physical Activity in Older Men and Women Post-Hip Fracture

“…As would be expected, those who were less cognitively impaired spent more time in physical activity, which is consistent with prior research (Cheval et al, 2022). Unfortunately, most rehabilitation interventions post-hip fracture focus on the recovery of older adults without cognitive impairment in clinical settings, and healthcare providers in rehabilitation settings are often not well trained to care for those with cognitive impairment (Cadel et al, 2022). Older adults with cognitive impairment are not as likely to adapt to rehabilitation when compared with similar individuals without cognitive impairment (Laver et al, 2020).…”

"I think we did the best that we could in the space:” A qualitative study exploring individuals’ experiences with three unconventional environments for patients with a delayed hospital discharge

“…For many years, hospitals in Canada and globally have been struggling with capacity pressures (e.g., admission surges due to overcrowded emergency departments and staffing shortages), which were further exacerbated by the COVID-19 pandemic [11][12][13][14]. In anticipation of inpatient surges from COVID-19, hospitals across Canada aimed to reduce in-patient occupancy during the earlier stages of the pandemic and it was reported that some Canadian hospitals (which typically operate close to or over 100% capacity) reduced their occupancy to 50% between March 2020 and June 2020 [15][16][17].…”