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96 Hip fracture and the influence of dementia on health outcomes and access to rehabiliation for older people
  1. Rebecca Mitchell1,2,
  2. Lara Harvey2,
  3. Henry Brodaty3,4,
  4. Brian Draper3,4,
  5. Jacqui Close2,4
  1. 1Macquarie University, Australia
  2. 2Neuroscience Research Australia, Australia
  3. 3Dementia Collaborative Research Centre, Australia
  4. 4University of New South Wales, Australia

Abstract

Background Recovery following hip fracture can be aided by access to, and participation in, rehabilitation-related activities. However, access to rehabilitation can differ for individuals with and without dementia. This study compares the characteristics and health outcomes of individuals with and without dementia following a hip fracture; and their access to and outcomes following hospital-based rehabilitation.

Methods An examination of hip fractures involving individuals aged 65 years and older with and without dementia using linked hospital separation, rehabilitation and mortality records during 1 January 2009 to 31 December 2013 in New South Wales, Australia. Comorbidities were identified using a 1-year lookback period and a modified Charlson Comorbidity Index. Logistic regression was used to examine the association of a hospital-based rehabilitation and individual characteristics.

Results There were 8,785 individuals with and 23,520 individuals without dementia who sustained a hip fracture. Individuals with dementia had a higher age-adjusted 30-day mortality rate compared to individuals without dementia (11.7% vs 5.7%), a lower proportion of age-adjusted 28-day re-admission (17.3% vs 24.4%), and a longer age-adjusted mean length of stay (22.2 vs 21.9 days). Compared to individuals without dementia, individuals with dementia had 4.3 times (95% CI: 3.90–4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission assessed using the Functional Independence Measure (p < 0.0001), but to a lesser extent than individuals without dementia.

Conclusions Within a population-based cohort, older individuals with dementia can benefit from access to, and participation in, rehabilitation activities following a hip fracture. This will ensure that they have the best chance of returning to their pre-fracture physical function and mobility.

  • dementia
  • hip fracture
  • rehabilitation
  • hospitalisation

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