2002 WHRG Grant Program

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Symposia

Rehabilitation of Cognitively Impaired Hip Fracture Patients
Ann Gruber-Baldini, Ph.D.
School of Medicine, University of Maryland, Baltimore

Patients with cognitive problems after hip fracture have poorer long-term outcomes including a greater likelihood of death, higher risk of nursing home placement, and poorer functional recovery. The role of cognitive status in the rehabilitation potential of hip fracture patients has not been extensively examined. In fact, those with cognitive limitations are frequently excluded from rehabilitation programs. In order to increase the understanding of the role of cognitive impairment in the rehabilitation of hip fracture patients, it is necessary to examine the selective placement into different types of rehabilitation, differential benefits of rehabilitation for those with cognitive limitations, and the type and quality of rehabilitation services that are provided for patients with cognitive limitations. Given limitations about what is known about rehabilitating those with cognitive impairment, preliminary information that can be used to design a definitive study in this area is needed. The proposed project will provide this essential preliminary information.

The proposed project will survey hospital discharge planners (n=10) and rehabilitation admissions personnel (n=20) to gather preliminary information on the criteria used for and difficulties in placing hip fracture patients with cognitive impairment. Information provided by these informants will be used to develop a questionnaire that can be administered to a larger sample and to identify types of settings most resistant to accepting hip facture patients with cognitive limitations. Measures of rehabilitation quality, strategy, and goals will be developed across multiple settings (home health, inpatient/outpatient subacute rehabilitation, subacute nursing home rehabilitation, skilled nursing facility) through observations of care and qualitative interviews with care providers across the different rehabilitation settings. The placement criteria used by different levels of rehabilitation/post-acute facilities for hip fracture patients is not known (especially in light of recent implementation of Medicare prospective payment for skilled nursing and subacute rehabilitation facilities) and measures of the rehabilitation environment are scarce.

The risk of hip fracture is almost twice as high in women as in men and about 75% of hip fracture patients are women. Furthermore, the prevalence of dementia is higher in women, and the caregivers of those with hip fracture and dementia are also more likely to be women. Because the number of elderly female patients admitted to hospital for hip surgery is high, improvements that result in better care for patients with cognitive impairments (including dementia and delirium) could result in a significant decrease in patient suffering and in the costs associated with acute and postacute care.

The proposed research will increase our understanding of the impact of cognitive impairment in hip fracture and could lead to better refined screening measures of "at-risk" groups of patients, better interventions for cognitive impairment, and improvement in rehabilitation outcomes for cognitive impaired hip fracture patients. Information gathered from this pilot research will be useful in developing grant applications for extramural funding.