Which rehabilitation strategies may optimize the outcomes for hip fracture patients with dementia?

The risk of hip fracture increases exponentially with age, above all in those persons defined as frail, who already are at high risk of becoming disabled or of worsening their disability. Despite progress in surgery and clinical care, hip fracture remains a catastrophic event, burdened with a high risk of mortality and residual disability: approximately one-third of patients are institutionalized, and half experience a permanent post-fracture disability.

Over 40% of people with hip fracture have dementia or cognitive impairment, which are generally associated with a worse rehabilitation outcome. Identifying rehabilitation strategies that promote the maximum functional recovery in this large subpopulation of patients is, therefore, of vital importance.

This Cochrane review by Smith and colleagues, updating a previous review published in 2013, has recently addressed this issue.

The authors aimed to assess the effects of enhanced rehabilitation strategies, designed either for persons with dementia or, more generally, for all older persons, on the rehabilitation outcomes of hip fracture patients with dementia. Their search selected seven trials with a total of 555 participants. No study was specifically designed for hip fracture patients with dementia; either enhanced rehabilitation models or a geriatrician-led care in-hospital for patients with hip fracture were compared to conventional care. No conclusion could be drawn on whether any of the considered models could improve quality of life or disability in activities of daily living in these patients. 

Enhanced care and rehabilitation in-hospital may reduce rates of postoperative delirium and are associated with lower rates of some other complications, and geriatrician-led management may lead to shorter hospital stay, but the certainty of these results is low. Thus, as the authors conclude, determining the optimal strategies to improve outcomes for these patients remains an unmet research priority.