Transition from inpatient rehabilitation to the home environment in cognitively impaired older persons after hip fracture

Abstract

Objective: To investigate short-term changes in clinical characteristics in the transition period be-tween geriatric inpatient rehabilitation and independent living at home in older patients with hip/pelvic fracture and cognitive impairment. Design: Longitudinal observational study. Subjects: A total of 127 multi-morbid, older patients with hip/pelvic fracture and cognitive impairment. Methods: Physical performance, fall-related self-efficacy, fear of falling, depressive symptoms, quality of life, and pain were assessed before discharge from geriatric inpatient rehabilitation and at home. Results: During the transition period (median 18.5 days; interquartile range 14–25 days), 25 participants dropped out due to admission to a nursing home (n = 11), withdrawal of consent (n = 8), death (n = 2), severe disease (n = 2), or other reasons (n = 2). Physical performance improved (p ≤ 0.001), while fall-related self-efficacy (p = 0.040) and fear of falling (p = 0.004) deteriorated. Depressive symptoms, quality of life, and pain did not change. Improve-ment in physical performance was associated with lower age, lower baseline physical performance, less baseline fear of falling, and living alone. Conclusion: While significant improvements in physical performance indicate a high potential for further enhancements in the majority of participants following inpatient rehabilitation, a considerable subgroup dropped out, partly indicating a negative trajectory in this vulnerable patient group. Sus-tained physical training or promotion of activity at home may further support rehabilitation in patients with hip/pelvic fracture and cognitive impairment.

Keywords

• short-term
• transition
• changes
• physical performance
• older persons.