Transition from inpatient rehabilitation to the home environment in cognitively impaired older persons after hip fracture
Bastian Abel, Tobias Eckert, Rebekka Pomiersky, Anja Dautel, Martina Schäufele, Klaus Pfeiffer, Klaus Hauer and the PROFinD2 Study Group
Department of Geriatric Research, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg, Germany.
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.
The prognosis regarding functional recovery in older persons with hip/pelvic fracture and cognitive impairment is poor, even after inpatient rehabilitation. Therefore, the period following inpatient rehabilitation is decisive regarding whether functionally and cognitively impaired persons can live at home or will lose their autonomy. The aim of this observational study was to investigate short-term changes in several clinical characteristics in the transition period between geriatric inpatient rehabili-tation and independent living at home in 127 vulnerable persons. While physical performance improved, fall-related self-efficacy and fear of falling deteriorated. Depressive symptoms, quality of life, and pain did not change. The improvements in physical performance indicate a high potential for further enhancement (e.g. by physical training or activity promotion at home) in the majority of participants. However, a considerable subgroup of 25 persons dropped out for various reasons (e.g. admission to a nursing home, death), which partly indicates a negative trajectory in this vulnerable patient group.
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