How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture ?

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Serval ID
serval:BIB_52AA0115A5F9
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture ?
Journal
BMC geriatrics
Author(s)
Seematter-Bagnoud L., Frascarolo S., Büla C.J.
ISSN
1471-2318 (Electronic)
ISSN-L
1471-2318
Publication state
Published
Issued date
12/03/2018
Peer-reviewed
Oui
Volume
18
Number
1
Pages
71
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
To investigate the association between isolated and combined affective and cognitive impairments with functional outcomes and discharge destination in older patients admitted to rehabilitation after a hip fracture.
Prospective study in 612 community-dwelling patients aged 65 years and over, admitted to rehabilitation after surgery for hip fracture. Information on socio-demographics, medical, functional, affective, and cognitive status was systematically collected at admission. Functional status, length of stay and destination were assessed at discharge. Functional improvement was defined as any gain on the Barthel Index score between admission and discharge from rehabilitation.
At admission, 8.2% of the patients had isolated affective impairment, 27.5% had cognitive impairment only, and 7.5% had combined impairments. Rate of functional improvement steadily decreased from 91.2% in patients with no cognitive nor affective impairment to 73.8% in those with combined impairments. Compared to patients without any impairment, those with combined impairments had lower odds of functional improvement, even after adjustment for age, gender, health and functional status at admission (adjOR: 0.40; 95%CI: 0.16-1.0; p = .049). The proportion of patients discharged back home gradually decreased from 82.8% among patients without any impairment to only 45.6% in patients with combined impairments. In multivariate analysis, the odds of returning home remained significantly reduced in these latter patients (adjOR: 0.31; 95%CI:0.15-0.66; p = .002).
Affective and cognitive impairments had both independent, and synergistic negative association with functional outcome and discharge destination in patients admitted to rehabilitation after a hip fracture. Nevertheless, patients with combined affective and cognitive impairments still achieved significant functional improvement, even though its magnitude was reduced. Further studies should investigate whether these patients would benefit from better targeted, longer, or more intensive rehabilitation interventions to optimize their functional recovery.

Keywords
Elderly persons, Functional status, Hip fracture, Mental status, Rehabilitation
Pubmed
Web of science
Open Access
Yes
Create date
15/03/2018 18:15
Last modification date
20/08/2019 14:08
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