Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial

Abstract

Objective to determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care. Design parallel randomised controlled trial with integrated health economic study. Setting NCFs, in Adelaide South Australia. Subjects people aged 70 years and older who were recovering from hip fracture surgery and were walking prior to hip fracture. Measurements primary outcomes: mobility (Nursing Home Life-Space Diameter (NHLSD)) and quality of life (DEMQOL) at 4 weeks and 12 months. Results participants were randomised to treatment ( n = 121) or control ( n = 119) groups. At 4 weeks, the treatment group had better mobility (NHLSD mean difference −1.9; 95% CI: −3.3, −0.57; P = 0.0055) and were more likely to be alive (log rank test P = 0.048) but there were no differences in quality of life. At 12 months, the treatment group had better quality of life (DEMQOL sum score mean difference = −7.4; 95% CI: −12.5 to −2.3; P = 0.0051), but there were no other differences between treatment and control groups. Quality adjusted life years (QALYs) gained over 12 months were 0.0063 higher per participant (95% CI: −0.0547 to 0.0686). The resulting incremental cost effectiveness ratios (ICERs) were $5,545 Australian dollars per unit increase in the NHLSD (95% CI: $244 to $15,159) and $328,685 per QALY gained (95% CI: $82,654 to $75,007,056). Conclusions the benefits did not persist once the rehabilitation program ended but quality of life at 12 months in survivors was slightly higher. The case for funding outreach home rehabilitation in NCFs is weak from a traditional health economic perspective. Trial registration ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry. Trial protocol available at

Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

“…People who have suffered fractures tend to limit their daily activities and simultaneously experience negative emotions such as depression, anxiety and decreased self-confidence. The FOF reduces flexibility, independence and balance of the body, thereby increasing the risk of falls [44,45]. We also found that the more chronic health disorders postmenopausal women have, the more likely they are to fall.…”

<p>Geriatric Interdisciplinary Home Rehabilitation After Hip Fracture in People with Dementia – A Subgroup Analysis of a Randomized Controlled Trial</p>

“…3 Despite dementia being common among older people with hip fracture and that the population has complex care needs, 6 the condition has often been an exclusion criterion for participation in previous clinical trials. 8 There is, however, growing evidence that people with hip fracture and cognitive impairment (CI) or dementia benefit from enhanced interdisciplinary rehabilitation in hospital, 9,10 combined in-hospital and in-home rehabilitation, [11][12][13][14] and from rehabilitation in nursing homes, 15 although the optimal rehabilitation strategies remain unclear. 6 To our knowledge, no previous team-based home rehabilitation (HR) interventions after hip fracture have included people with severe CI or dementia.…”

People living in nursing care facilities who are ambulant and fracture their hips: description of usual care and an alternative rehabilitation pathway

“…Our data suggest nursing home residents who had multiple co-morbidities and marked dementia appeared to respond favourably to medical and allied health intervention in this current study, at least while the rehabilitation was ongoing. However, once the rehabilitation was withdrawn at 4 weeks, their risk for death increased [4]. The combined medical, physiotherapy and dietetic interventions did reduce early mortality, but it is not known whether an extended program may have promoted sustained mortality benefits and ongoing functional improvements.…”

“…These adverse events were able to be classified in four main categories: Falls, Skin tears/wounds, Medical (Chest infection/pneumonia) and Medical (other). Mortality and re-fracture rates data has already been reported in the main study publication [4] . Falls were the most commonly reported adverse event (n = 258), with those receiving the addition of in-reach rehabilitation incurring 62.7% of the falls, with 12 people (21%) requiring hospital admission and three people sustaining hip fractures.…”

“…The SACRED trial (ACTRN12612000112864 registered on the Australian and New Zealand Clinical Trials Registry (ANZCTR)) recruited 240 older people from NCFs who were previously mobile and had fractured their hips and randomly allocated them to receive a 4 week in-reach geriatric rehabilitation program or usual care on discharge [4]. This study involved very old people (mean age 88.6 years (SD 5.6)) most of whom suffered with dementia.…”