Treatment of dementia patients with fracture of the proximal femur in a specialized geriatric care unit compared to conventional geriatric care

Abstract

To prove the efficiency of a specialized geriatric ward (cognitive geriatric unit, CGU) for patients with a fracture of the proximal femur and additional dementia, we conducted a matched-pair analysis comparing 96 patients with fracture of the proximal femur and additional dementia matched for age, sex, surgical treatment and the degree of cognitive impairment by MMSE score. A total of 48 patients were treated in the CGU, offering extended geriatric assessment, special education of staff, and architecture appropriate for patients with cognitive decline. Target criteria were a gain in the Barthel index and Tinetti score, the length of stay, new admissions to nursing home, the frequency of neuroleptic, antidepressant, and antidementive medication, and the number of specified clinical diagnoses for the dementia syndrome. Length of stay was significantly longer in the CGU. The increase of the Tinetti score was significantly higher in the patients in the CGU, regardless of the length of stay (analysis of covariance: treatment (CGU/non-CGU): F(1/93) = 9.421, p = 0.003; covariate (length of stay): F(1/93) = 3.452, p = 0.066, η(2) = 3.6%). In the intervention group, the number of definite diagnoses concerning the dementia syndrome was also higher. Comparison of drug treatment and the percentage of new admission to a nursing home did not differ between groups. Treatment in a specialized, "cognitive geriatric unit" seems to result in better mobility of demented patients with proximal fractures of the femur.

Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review

“…Of the seven relevant studies, two were randomized controlled trials 13,14 , one was a single group pre- and post-test 15 , one was a descriptive comparison between those with and without cognitive impairment 16 , one was a case controlled matched trial 17 , one was a nonequivalent groups trial 18,19 , and one was a case report 20 . As described in Table 3, the interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals.…”

“…Three of the studies tested a team based approach to rehabilitation to augment what would otherwise be referred to as routine rehabilitation and therapy 14,17,18 . In the study by Huusko 14 , individuals were either sent to a specialized rehabilitation facility or usual care and rehabilitation.…”

“…The case controlled matched group trial by Rosler 17 likewise addressed management of individuals with cognitive impairment by augmenting the team approach and testing rehabilitation outcomes on a Cognitive Geriatric Unit. The unit incorporated environmental changes such as hidden exit doors, a loop track for free wandering, increased lighting, a unit based treatment room for therapy and a living and eating room to make it more home like.…”

“…Two of the studies included those with cognitive impairment unless the impairment was severe (defined as an MMSE of ≤ 14) 15 or there was severe impairment with no caregiver available 13 . The study by Rosler 17 included a small sub-study analysis of those individuals with a diagnosis of dementia (mean MMSE =14.5, SD=6.4).…”

Geriatric Patients With Cognitive Impairment

“…The first specialized geriatric ward in Germany was established at the Elisabeth Hospital in Essen in 1990 (by Prof. Nehen); since 2000, the number of such units has been growing steadily (28,29), though very little information about them has been published to date (30)(31)(32).…”