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An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study

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Abstract

Summary

This study examined hip fracture hospitalisation trends and predictors of access to rehabilitation for adults aged ≥ 65 years living with and without dementia. The hospitalisation rate was 2.5 times higher for adults living with dementia and adults who lived in aged care were between 4.8 and 9.3 times less likely to receive rehabilitation.

Introduction

To examine hip fracture hospitalisation temporal trends, health outcomes, and predictors of access to in-hospital rehabilitation for older adults living with and without dementia.

Methods

A population-based retrospective cohort study of adults aged ≥ 65 years hospitalised with a hip fracture during 2007–2017 in New South Wales, Australia.

Results

Of the 69,370 hip fracture hospitalisations, 27.1% were adults living with dementia. The hip fracture hospitalisation rate was 2.5 times higher for adults living with dementia compared with adults with no dementia (1186.6 vs 492.9 per 100,000 population). The rate declined by 6.1% per year (95%CI − 6.6 to − 5.5) for adults living with dementia and increased by 1.0% per year (95%CI 0.5–1.5) for adults with no dementia. Multivariable associations identified that adults living with dementia who experienced high frailty and increasing age were between 1.6 and 1.8 times less likely to receive in-hospital rehabilitation. Adults who were living in long-term aged care facilities were between 4.8 and 9.3 times less likely to receive in-hospital rehabilitation which varied by the presence of dementia or delirium.

Conclusion

Consistent criteria should be applied to determine rehabilitation access, and rehabilitation services designed for older adults living with dementia or in aged care are needed.

Highlights

• Adults living with dementia were able to make functional gains following hip fracture rehabilitation.

• Need to determine consistent criteria to determine access to hip fracture rehabilitation.

• Rehabilitation services specifically designed for adults living with dementia or in aged care are needed.

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References

  1. Curtis EM, Moon RJ, Harvey NC, Cooper C (2017) Reprint of: the impact of fragility fracture and approaches to osteoporosis risk assessment worldwide. Int J Orthop Trauma Nurs 26:7–17

    Article  Google Scholar 

  2. Cooper C et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22(5):1277

    Article  CAS  Google Scholar 

  3. Gullberg B, Johnell O, Kanis J (1997) World-wide projections for hip fracture. Osteoporos Int 7:407–413

    Article  CAS  Google Scholar 

  4. Harvey N, Dennison E, Cooper C (2010) Osteoporosis: impact on health and economics. Nat Rev Rheumatol 6(2):99–105

    Article  Google Scholar 

  5. Australian Institute of Health and Welfare, Hip fracture incidence and hospitalisations in Australia 2015–16, in Cat. no. PHE 226. 2018, AIHW: Canberra

  6. Muir S, Yohannes A (2009) The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 32(24–32)

  7. Seitz DP et al (2011) Prevalence of dementia and cognitive impairment among older adults with hip fractures. J Am Med Dir Assoc 12(8):556–564

    Article  Google Scholar 

  8. Dementia Australia, Dementia Prevalence Data 2018-2058. 2018, NATSEM, University of Canberra: Canberra

  9. Patrick L et al (2001) Medical comorbidity and rehabilitation efficiency in geriatric inpatients. JAGS 49:1471–1477

    Article  CAS  Google Scholar 

  10. Hershkovitz A, Kalandariov Z, Hermush V, Weiss R, Brill S (2007) Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil 88:916–921

    Article  Google Scholar 

  11. Adunsky A et al (2003) A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. J Genontol 58A(6):542–547

    Article  Google Scholar 

  12. McGilton K et al (2007) Rehabilitating patients with dementia who have had a hip fracture. Part II cognitive systems that influence care. Top Geriatr Rehabil 23(2):174–182

    Article  Google Scholar 

  13. Morghen S et al (2011) Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. J Am Geriatr Soc 59:1497–1502

    Article  Google Scholar 

  14. Chin R, Ng B, Cheung L (2008) Factors predicting rehabiliation outcomes of elderly patients with hip fracture. Hong Kong Med J 14(3):209–215

    PubMed  Google Scholar 

  15. Toots A, Littbrand H, Lindelöf N, Wiklund R, Holmberg H, Nordström P, Lundin-Olsson L, Gustafson Y, Rosendahl E (2016) Effects of a high-intensity functional exercise program on depedence in activities of daily living and balance in older adults with dementia. J Am Geriatr Soc 64:55–64

    Article  Google Scholar 

  16. Lam FM et al (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. J Phys 64(1):4–15

    Google Scholar 

  17. Australian Bureau of Statistics, Australian demographic statistics. Cat. no. 3101.0. 2016, Canberra: ABS

  18. Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, Januel JM, Sundararajan V (2011) Updating and validating the Charlson Comorbidity Index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol 173(6):676–682

    Article  Google Scholar 

  19. Gilbert T, Neuburger J, Kraindler J, Keeble E, Smith P, Ariti C, Arora S, Street A, Parker S, Roberts HC, Bardsley M, Conroy S (2018) Development and validation of a Hospital Frailty Risk Score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet 391(10132):1775–1782

    Article  Google Scholar 

  20. Australian Bureau of Statistics, Australian Statistical Geographical Standard Remoteness Area. 2011, Australian Bureau of Statistics: Canberra

  21. Access Economics, Dementia across Australia: 2011-2050. 2011, Alzheimer’s Australia: Canberra

  22. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 10:430–439

    Article  Google Scholar 

  23. Mitchell, R., et al., Hip fracture and the influence of dementia on health outcomes and access to rehabilitation. Disability and Rehabilitation, 2016: p. Online 14/1/2016

  24. Australian and New Zealand Hip Fracture Registry Steering Group, Australian and New Zealand guideline for hip fracture care. 2014, Australian and New Zealand Hip Fracture Registry Steering Group: Sydney

  25. Wells J et al (2003) State of the art in geriatric rehabiliation. Part I: Review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehabil 84:890–897

    Article  Google Scholar 

  26. World Health Organization, Rehabilitation 2030: a call for action. 2017, WHO: Geneva

  27. Buckwalter JA, DiNubile NA (1997) Decreased mobility in the elderly: the exercise antidote. Phys Sportsmed 25(9):126–133

    Article  CAS  Google Scholar 

  28. Harvey L, Mitchell R, Brodaty H, Draper B, Close J (2016) Differing trends in fall-related fracture and non-fracture injuries in older people with and without dementia. Arch Gerontol Geriatr 67:61–67

    Article  Google Scholar 

  29. Chang K-H, Chung CJ, Lin CL, Sung FC, Wu TN, Kao CH (2014) Increased risk of dementia in patients with osteoporosis: a population-based retrospective cohort analysis. Age 36(2):967–975

    Article  Google Scholar 

  30. Oden A et al (2015) Burden of high fracture probability worldwide: secular increases 2010–2040. Osteoporos Int 26(9):2243–2248

    Article  CAS  Google Scholar 

  31. Sharma S, Mueller C, Stewart R, Veronese N, Vancampfort D, Koyanagi A, Lamb SE, Perera G, Stubbs B (2018) Predictors of falls and fractures leading to hospitalization in people with dementia: a representative cohort study. J Am Med Dir Assoc 19(7):607–612

    Article  Google Scholar 

  32. Büchele G, Becker C, Cameron ID, König HH, Robinovitch S, Rapp K (2014) Predictors of serious consequences of falls in residential aged care: analysis of more than 70,000 falls from residents of Bavarian nursing homes. J Am Med Dir Assoc 15(8):559–563

    Article  Google Scholar 

  33. Cameron ID et al (2018) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 9:1465–1858

    Google Scholar 

  34. Beaupre LA, et al. 2019 Rehabilitation after hip fracture for nursing home residents: a controlled feasibility trial. J Gerontol: Series A, in press

  35. Crotty M, et al. 2019 Should we provide outreach rehabilitation to very old people living in nursing care facilities after a hip fracture? A randomised controlled trial. Age and Ageing

  36. Mitchell R et al (2019) Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals’ views. Disabil Rehabil:1–12

  37. Cations, M., et al. 2019 Health professional perspectives on rehabilitation for people with dementia. The Gerontologist, inpress

  38. Lee H et al (2017) Impact of delirium after hip fracture surgery on one-year mortality in patients with or without dementia: a case of effect modification. Am J Psychiatr 25(3):308–315

    Google Scholar 

  39. Buddingh S, Liang J, Allen J, Koziak A, Buckingham J, Beaupre LA (2013) Rehabilitation for long-term care residents following hip fracture: a survey of reported rehabilitation practices and perceived barriers to delivery of care. J Geriatr Phys Ther 36(1):39–46

    Article  Google Scholar 

  40. Seitz DP, Gill SS, Austin PC, Bell CM, Anderson GM, Gruneir A, Rochon PA (2016) Rehabilitation of older adults with dementia after hip fracture. J Am Geriatr Soc 64(1):47–54

    Article  Google Scholar 

  41. Beaupre LA et al (2013) Maximising functional recovery following hip fracture in frail seniors. Best Pract Res Clin Rheumatol 27(6):771–788

    Article  Google Scholar 

  42. Sheehan K et al (2019) Inequity in rehabilitation interventions after hip fracture: a systematic review. Age Ageing 48(4):489–497

    Article  CAS  Google Scholar 

  43. Clague JE et al (2002) Predictors of outcome following hip fracture. Admission time predicts length of stay and in-hospital mortality. Injury 33(1):1–6

    Article  Google Scholar 

  44. Henderson T, Shepheard J, Sundararajan V (2006) Quality of diagnosis and procedure coding in ICD-10 administrative data. Med Care 44(11):1011–1019

    Article  Google Scholar 

  45. Schrijvers EM, Verhaaren BF, Koudstaal PJ, Hofman A, Ikram MA, Breteler MM (2012) Is dementia incidence declining?: trends in dementia incidence since 1990 in the Rotterdam Study. Neurology 78(19):1456–1463

    Article  CAS  Google Scholar 

  46. Satizabal CL et al (2016) Incidence of dementia over three decades in the Framingham Heart Study. N Engl J Med 374(6):523–532

    Article  CAS  Google Scholar 

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Acknowledgements

The authors wish to thank the NSW Ministry of Health for providing access to the hospitalisation, rehabilitation, and mortality data, and the Centre for Health Record Linkage for conducting the data linkage.

Funding

This study was funded by Macquarie University through the SafetyNet funding program. RM was supported by a career fellowship from the NSW Ministry of Health under the NSW Health Early-Mid Career Fellowships Scheme.

Author information

Authors and Affiliations

  1. Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia

    R. Mitchell, H.P. Ting, R. Lystad & J. Braithwaite

  2. Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia

    B. Draper & H. Brodaty

  3. Centre for Healthy Brain Ageing, School of Psychiatry, UNSW Australia, Sydney, Australia

    B. Draper & H. Brodaty

  4. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia

    J. Close & L. Harvey

  5. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

    J. Close

  6. Whitlam Orthopaedic Research Centre, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia

    I. Harris

  7. School of Public Health, University of Sydney, Sydney, Australia

    C. Sherrington

  8. John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Sydney, Australia

    I.D. Cameron

Authors
  1. R. Mitchell
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  2. B. Draper
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Corresponding author

Correspondence to R. Mitchell.

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Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee (2018HRE0207).

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Mitchell, R., Draper, B., Brodaty, H. et al. An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporos Int 31, 465–474 (2020). https://doi.org/10.1007/s00198-019-05260-8

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  • DOI: https://doi.org/10.1007/s00198-019-05260-8

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