Longitudinal functional recovery after postacute rehabilitation in older hip fracture patients: the role of cognitive impairment and implications for long-term care.

OBJECTIVE: To compare functional recovery patterns of cognitively impaired and nonimpaired older adults who had hip fracture surgeries, and to identify associated long-term care needs.
METHODS: Longitudinal study (n = 231). Data were collected within 72 hours of admission to and before discharge from the postacute rehabilitation facilities and at 2, 6, and 12 months following postacute rehabilitation discharge. Six functional independence measures (FIM) were used to assess functional recovery. Mini-mental status examination was used to gauge cognitive function. Mixed-effects analyses quantify differences of FIM functional recovery patterns between groups while adjusting for potential confounders.
RESULTS: Multivariate results showed that patients with impaired cognition had notably different functional recovery patterns and significantly worse overall FIM scores (P < .001) than their counterparts in all 6 FIM functions. For locomotion function at 1 year, cognitively nonimpaired patients needed little supervision (mean FIM = 5.6), whereas patients with impaired cognition needed 50% human assistance (FIM = 3.9). In addition to needing locomotion assistance, cognitively impaired patients also required 25% human assistance in transfers (FIM = 4.8), 25% in self-care (FIM mean = 5.3), and 25% in sphincter control (FIM mean = 5.0).
CONCLUSION: Cognitively impaired patients experienced recovery at 2 and 6 months but were unable to retain rehabilitation gains in locomotion, transfers, self-care, and sphincter control at 1 year following postacute rehabilitation discharge, and they still required human assistance to stay in their homes within the community. To prevent or delay nursing home entry, it is suggested that appropriate long-term care planning and social support for caregivers are needed for cognitively impaired hip fracture patients.