Rehabilitation interventions for older adults with a hip fracture and cognitive impairment: Systematic review


Introduction: A hip fracture in older adulthood can result in function and mobility decline. The consequences are debilitating and place a great burden on patients, caregivers, and the healthcare system. Although inpatient rehabilitation programs have proven effective, the best practices required to maintain the gains in function and mobility, and to enable this population to continue living at home, are currently unknown. Purpose: To identify and assess 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.  Methods: The methods outlined in the Cochrane Handbook for Systematic Reviews of Intervention were followed and findings were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they had participants who underwent hip fracture surgery, and had any form of 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.  Findings were synthesized to determine which components of the identified outpatient interventions were the most beneficial to this patient population. Results: The original search resulted in over three thousand articles. Four studies, two of which used the same data pool, satisfied the necessary criteria to be included in the systematic review. All studies included inpatient and outpatient physiotherapy, with some including a cognitive component, family education, and a discharge assessment. All studies were reported as successful. Conclusion: Findings provide support for the necessity of community driven rehabilitation options for this population to remain independent. These findings will be used to inform the development of a multi-faceted home-based outpatient rehabilitation program aimed at enabling older adults remain living at home after a hip fracture.

Acknowledgments: Technology Evaluation in the Elderly