Post-discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Research Results
Findings: After analysis, three RCTs with 563 participants were included. Significant improvements in activities of daily living and mobility were reported in two studies for those with CI. All three interventions began during inpatient hospitalization, followed by discharge planning, and physiotherapist visits at home. All three interventions varied in length and components (i.e. only one included nurse home visits). All studies were conducted outside of North America. From the studies, no intervention was specifically designed for people with CI and none of the studies evaluated cost-effectiveness. The results of the review suggest promising results to improve physical function, mobility and ADLs within 1-year of participating in community-based rehabilitation interventions post hospital discharge from inpatient care for older adults with CI. Review results also showed an increased likelihood of returning home for a short (3-month) period post-discharge.
The project led us to suggest that interventions in this realm should: (1) start early in the trajectory of care while the patient is in inpatient rehabilitation and pre-emptively include discharge planning discussions; (2) be designed with the inclusion of physiotherapy to address the physical components of rehabilitation; and (3) be executed by an interdisciplinary team to provide multifaceted care that continues into the community setting.
Impact of findings: Critical gaps were identified from our review which will inform the development of a multifaceted outpatient community-based rehabilitation program for older adults with cognitive impairment. Future rehabilitation interventions should be focused and tailored to those with CI and include a cost analysis.
Publications, presentations and webinars
For more information on why this research matters, click the links below:
About the Project
Each year in Canada, many seniors experience a hip fracture complicated by the presence of CI such as delirium or dementia. Following inpatient rehabilitation, the maintenance of functional gains among persons with CI is of utmost importance.
A structured rehabilitation plan provided to patients post-discharge that includes effective community- and home-based interventions informed by evidence-based best practice will ensure that this population remains independent in the community and will reduce the burden on both caregivers and the health care system.
For more details on the project rationale, objectives and research plan, click here.
Project Team
Principal Investigators:
Katherine McGilton, PhD, RN — Toronto Rehabilitation Institute, University Health Network
Paula van Wyk, PhD — University of Windsor
Co-Investigators:
Dina Brooks, PhD, PT — University of Toronto
Martine Puts, PhD, RN — University of Toronto
Knowledge Users and Partners:
Lauren Beaupre, PhD — Canadian Bone and Joint Network
John Flannery, MD, BSc — Toronto Rehabilitation Institute, University Health Network
Margaret Keatings — retired Chief Nursing Officer, caregiver
Charissa Levy, MHSc, BSc — GTA Rehabilitation Network
Rhona McGlasson, PT, MBA — Canadian Bone and Joint Network
Project Contact: Paula van Wyk — pvanwyk@uwindsor.ca
KS 2013-05
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Project Contact: Paula van Wyk — pvanwyk@uwindsor.ca
Key Findings for Families
The study found that community-based rehabilitation after breaking a hip can improve mobility and activities of daily living among older adults with memory problems
The results of this study provide support for creating more community-based rehabilitation for older adults with memory problems that break a hip.
- This research suggests that community-based rehabilitation after breaking a hip is helpful for older adults with memory problems, but more research is needed to guide the type of rehabilitation provided
Why This Matters
Hip fractures are occurring more often because of the increasing number of older adults. Broken hips can lead to other problems. This can place a major burden on the patient, their family/caregivers and the healthcare system. While it is known that rehabilitation in hospital can help people get better after breaking their hip, there are no standards for continuing rehabilitation once patients go home.
About This Study
- This study used systematic review methods. A systematic review is a way to find all research on rehabilitation after breaking a hip for older adults with CI
- Studies were included if they studied older adult who had memory problems and had broken their hip. The studies that were included in this review looked at how helpful rehabilitation was after older adults with memory problems were discharged from hospital after breaking their hip
- The results of all of the studies were combined to see how helpful rehabilitation was after being in hospital
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Project Contact: Paula van Wyk — pvanwyk@uwindsor.ca
Key Findings for Policy
- The evidence suggests the rehabilitation after discharge from hospital can improve mobility and activities of daily living after a hip fracture among older adults with CI
- There are limited community-based rehabilitation programs for older adults with CIs following hip fracture
The results of this study provide support for the need for community-based rehabilitation following a hip fracture for older adults with a cognitive impairment.
- While this study found evidence to suggest that rehabilitation following a hospital discharge related to a hip fracture among older adults with CI is beneficial, there is a paucity of evidence to suggest what this intervention should consist of
Why This Study was Needed
As the population ages the rate of hip fractures is increasing. Hip fractures are a major concern because they can be associated with complications that result in burdens on the patient and their caregivers, and can be costly to the healthcare system. Although advancements have been made for inpatient hip fracture rehabilitation programs or guidelines for continued practices once patients transition back to the community setting, which may ease the burden of hip fractures.
Study Summary
- This study used systematic review methods to find and synthesize all medical research on the use of community-based rehabilitation among older adults with CI who had a hip fracture
- Studies included in this review were studies of older adults with CIs that had a hip fracture. The included studies looked at the efficacy of community-based rehabilitation in this population
- Over 3,000 references were identified and only three articles were included in the review
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Project Contact: Paula van Wyk — pvanwyk@uwindsor.ca
Key Findings for Researchers
- The evidence suggests the rehabilitation after discharge from hospital can improve mobility and activities of daily living after a hip fracture among older adults with CI
- There are limited community-based rehabilitation programs for older adults with CIs following hip fracture
The study findings support the need for community-based rehabilitation and improved interventions following a hip fracture in older adults with a CI.
- While this study found evidence to suggest that rehabilitation following a hospital discharge related to a hip fracture among older adults with CI is beneficial, there is a paucity of evidence to suggest that this intervention is available
Why This Study was Needed
Hip fracture rates are increasing in relation to the aging population, and are associated with significant complications. This can place a major burden on the patient, their family/caregivers and the healthcare system. Although advancements have been made for inpatient hip fracture rehabilitation programs for older adults with or without a CI, there are no current programs or guidelines for continued practices once patients transition back to the community setting.
How This Study Addresses the Gap
- A systematic review was undertaken to examine the efficacy of community-based rehabilitation for older adults with CIs following hip fractures
- This search strategy, which included a combination of text words and subject headings relating to CI, dementia, delirium, cognitive reserve and hip fractures was run in eight medical databases. Studies had to involve participants with CI who underwent hip fracture surgery, and examined an outpatient intervention that occurred in the participant’s home or community
- Over 3,000 references were identified and only three studies were included
Future Research
- Results indicate the lack of clarity of the components of an outpatient rehabilitation intervention for individuals with CI following a hip fracture
- Future research evaluating these interventions should consider utilizing standardized outcome measures, cognitive assessments and detailed participant description
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Principal Investigators
Katherine McGilton, PhD, RN — Toronto Rehabilitation Institute, University Health Network
Paula van Wyk, PhD — University of Windsor
Publications
van Wyk, P.M., Chu, C.H., Babineau, J., Puts, M., Brooks, D., Saragosa, M., McGilton, K.S. (2014). Community-based rehabilitation post hospital discharge interventions for older adults with cognitive impairment following a hip fracture: a systematic review protocol. JMIR Res Protoc; 3(3):e47. DOI: 10.2196/resprot.3485 PMID: 25227119 PMCID: 4180327.
Chu, C.H., Paquin, K., McGilton, K.S., van Wyk, P.M. (2014). Community based rehabilitation interventions after discharge from inpatient rehabilitation for older adults with hip fracture and cognitive impairment: preliminary findings of a systematic review. 43rd Annual Scientific and Educational Meeting Canadian Association on Gerontology (CAG). Niagara Falls, ON.
Paquin, K., Chu, C., McGilton, K.S., van Wyk, P.M. (2014). Rehabilitation interventions for older adults with a hip fracture and cognitive impairment: systematic review. SCAPPS Annual Conference. London, ON.
van Wyk, P.M., Chu, C., Puts, M., Brooks, D., Paquin, K., McGilton, K.S. (2014). Community based rehabilitation post hospital discharge interventions for older adults with cognitive impairment following a hip fracture: a systematic review. The Gerontological Society of America’s 67th Annual Scientific Meeting. Washington, DC.
Presentations
van Wyk, P.M., Paquin, K., Chu, C., Babineau, J., Puts, M., Brooks, D, McGilton, K.S. (2014). Community based rehabilitation post hospital discharge interventions for older adults with cognitive impairment following a hip fracture: a systematic review. 2nd Annual TVN Conference on Improving Care for the Frail Elderly. Toronto, ON.
van Wyk, P.M. (2014). Post-discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture. 2nd Annual TVN Conference on Improving Care for the Frail Elderly. Toronto, ON.
Webinars
Post-discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture — Katherine McGilton and Paula van Wyk
The objective of this research project was to find evidence of effective community, including home-based, rehabilitation interventions for older adults with cognitive impairment (CI) following a hip fracture.
Principal Investigators
Katherine McGilton, PhD, RN — Toronto Rehabilitation Institute, University Health Network
Paula van Wyk, PhD — University of Windsor
Rationale: There is a gap in our knowledge with respect to the effectiveness of outpatient rehabilitation interventions provided to older adults with a cognitive impairment (CI) that have been discharged from acute care or in-patient rehabilitation following hip fracture surgery.
Objectives: This systematic review looked at the evidence for all modes of post discharge rehabilitation interventions in community settings, including home-based, for older adults with a CI following a hip fracture.
Research Plan: Medline In-Process, Pubmed, PsycINFO, Embase, CINAHL, AMED and three other databases were searched, resulting in 52 articles for full extraction. Studies were included if they had participants who underwent hip fracture surgery, and had CI; and conducted an outpatient intervention that takes place in the home or community. Two reviewers independently performed data extraction and assessed the methodological quality of each article.