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 between 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. Improvement 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. Sustained physical training or promotion of activity at home may further support rehabilitation in patients with hip/pelvic fracture and cognitive impairment.