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REHABILITATION AFTER HIP FRACTURE IN PATIENTS WITH DEMENTIA
Author(s) -
Giusti Andrea,
Barone Antonella,
Pioli Giulio
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01258.x
Subject(s) - medicine , hip fracture , dementia , rehabilitation , physical therapy , cohort study , activities of daily living , cohort , prospective cohort study , physical medicine and rehabilitation , osteoporosis , disease
To the Editor: The rehabilitation of patients with dementia who fracture their hip is associated with poor functional outcomes, although cognitive impairment is not a barrier to functional recovery per se. Even if the role of the environment in the care of patients with dementia is well known, limited data focusing on the best rehabilitation setting in postacute patients with dementia are available. Only a small number of studies have considered homebased rehabilitation (HBR) in older people after hip fracture, and none of them included subjects with cognitive impairment. In a prospective cohort study of community-dwelling subjects with hip fracture, we previously demonstrated that HBR and institutional-based rehabilitation (IBR) produce comparable results in terms of functional outcomes, even when subjects with premorbid cognitive impairment or functional disability are included in HBR. The aim of the present research was to evaluate functional recovery in patients with dementia who fracture their hip and to compare the effects of HBR and IBR. METHODS All the patients consecutively admitted to the Genoa Galliera Hospital (Italy) over the period of 1 year (2001) with an osteoporotic hip fracture were eligible for inclusion in the study if they were aged 70 and older, were living in the community at the time of fracture, had surgical stabilization of the fracture, were discharged alive, and had cognitive impairment as assessed using the Short Portable Mental Status Questionnaire (SPMSQ). According to the score limits for SPMSQ (score range 0–10) proposed previously, patients with a SPMSQ score lower than 8 (score 0–7) were categorized as having dementia. As part of a comprehensive geriatric assessment, all the patients were evaluated for their ability to perform basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs; Barthel Index for ADLs and Lawton Index for IADLs), medical burden, and severity of illness (Cumulative Illness Rating Scale (CIRS)). After surgical treatment, patients were discharged to a rehabilitation facility or a home care program based on their preferences. Different agencies of the healthcare system provided HBR and IBR. The specific content and duration of the training program therapy, described elsewhere, were left to the discretion of the individual therapists. Telephone follow-up interviews were conducted at 3, 6, and 12 months to assess functional status using a questionnaire based on the Barthel Index, adapted for telephone interview. Baseline characteristics between subjects of the two rehabilitation settings (HBR vs IBR) were compared using