Treatment of Pain in Cognitively Impaired Compared with Cognitively Intact Older Patients with Hip-Fracture

Introduction The number of patents with dementia increases among hip fracture patients. Cognitive dysfunction is defined as a premorbid state which is potentionally negatively related to short-term functional outcome. Objective To assess the relationship between cognitive status on admission and functional gain during an early rehabilitation period in elderly hip fracture patients. Methods Forty-five elderly patients with surgically treated hip fracture were examined. Cognitive status was assessed by the Mini Mental State Examination (MMSE) at admission; functional status was assessed by the motor subscale of Functional Independence Measure (FIM) at admission and before discharge, while absolute functional gain was determined by the motor FIM gain (FIM discharge - FIM admission). Absolute functional gain was analyzed in respect to cognitive status. Results Both cognitively impaired and cognitively intact hip fracture patients exhibited overall FIM motor improvements, as well as functional gains in specific FIM motor areas (p<0.01). Absolute functional gain, however, was higher in 1) cognitively intact compared to cognitively impaired patients (p<0.01), and 2) cognitively moderately impaired patients compared to severely cognitively impaired patients (p<0.01). No difference in functional gain was detected between the patients with moderately cognitively impaired compared to the cognitive intact patients (p>0.05). Conclusion The systematic use of MMSE identifies cognitively impaired hip fracture patients, and effectively predicts their short-term functional outcome. A higher admission cognitive status is related to a more favorable short term rehabilitation outcome. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes. The systematic identification of cognitively impaired hip fracture patients at admission facilitates optimal treatment and rehabilitation, and thus enables the best achievable outcome to be reached.

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Machine Learning Algorithms to Predict Mortality and Allocate Palliative Care for Older Patients With Hip Fracture

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.09.025 ◽

2020 ◽

Author(s):

Michael P. Cary ◽

Farica Zhuang ◽

Rachel Lea Draelos ◽

Wei Pan ◽

Sathya Amarasekara ◽

...

Keyword(s):

Machine Learning ◽

Palliative Care ◽

Hip Fracture ◽

Older Patients ◽

Learning Algorithms ◽

Machine Learning Algorithms

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Osteoporosis Assessment and Treatment in Older Patients who Have Sustained a Hip Fracture

Scottish Medical Journal ◽

10.1258/rsmsmj.51.2.32 ◽

2006 ◽

Vol 51 (2) ◽

pp. 32-35 ◽

Cited By ~ 5

Author(s):

Douglas W Lowdon ◽

Catherine Quinn ◽

Pat Mole ◽

Graham P Leese

Keyword(s):

Hip Fracture ◽

Older Patients ◽

Assessment And Treatment

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The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Reviews in Clinical Gerontology ◽

10.1017/s0959259814000100 ◽

2014 ◽

Vol 24 (3) ◽

pp. 219-227 ◽

Cited By ~ 2

Author(s):

Francisco J Tarazona-Santabalbina ◽

Juan R Doménech-Pascual ◽

Ángel Belenguer-Varea A ◽

Eduardo Rovira Daudi

Keyword(s):

Cognitive Impairment ◽

Hip Fracture ◽

Functional Recovery ◽

Functional Outcomes ◽

Older Patients ◽

Future Research ◽

Research Perspectives ◽

Increased Risk ◽

Risk Of Falls

SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

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The association between sarcopenia and functional outcomes among older patients with hip fracture undergoing in-hospital rehabilitation

Osteoporosis International ◽

10.1007/s00198-017-3929-z ◽

2017 ◽

Vol 28 (5) ◽

pp. 1569-1576 ◽

Cited By ~ 37

Author(s):

F. Landi ◽

R. Calvani ◽

E. Ortolani ◽

S. Salini ◽

A. M. Martone ◽

...

Keyword(s):

Hip Fracture ◽

Functional Outcomes ◽

Older Patients ◽

Hospital Rehabilitation

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Six Versus 12 Weeks of Outpatient Physical Therapy Including Progressive Resistance Training in Cognitively Intact Older Adults After Hip Fracture: A Multicenter Randomized Controlled Trial

The Journals of Gerontology Series A ◽

10.1093/gerona/glab256 ◽

2021 ◽

Author(s):

Jan A Overgaard ◽

Thomas Kallemose ◽

Kathleen K Mangione ◽

Morten T Kristensen

Keyword(s):

Older Adults ◽

Randomized Controlled Trial ◽

Hip Fracture ◽

Physical Therapy ◽

Controlled Trial ◽

Community Dwelling ◽

Walking Distance ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial ◽

Cognitively Intact

Abstract Background Recovery of function and regaining muscle strength are challenging after hip fracture. We compared the effectiveness of a 12- versus 6-week outpatient physical therapy program with progressive resistive training (PRT) to increase strength and physical performance. Methods This parallel, superiority, 2-group randomized controlled trial was conducted in 4 clinics that enrolled community-dwelling, cognitively intact older adults (+60 years) with a surgical repair of a hip fracture and no major medical conditions. Participants received 12 or 6 weeks of PRT and standardized physical therapy, twice weekly. Pain was monitored throughout. Primary outcome was the change in the 6-minute walk test (6MWT) from baseline to 12-week follow-up. Randomization via a computer-generated allocation sequence was implemented using sealed, sequentially numbered opaque envelopes and assessors were blinded to group assignment. Results Participants (81% women) with a mean (SD) age of 77 (8.1) years were enrolled at an average of 18 days after hip fracture surgery and randomized into a 12-week group (n = 50) or a 6-week group (n = 50). Mean (SD) change scores in the 6MWT were 143.8 (81.1) and 161.5 (84.1) m in the 12- and 6-week groups, respectively (both exceeding the minimal clinically important difference of 55 m). The mean between-group difference was −17.7 m (95% CI −50.1, 14.8). Pain during training did not exceed moderate levels nor increase as training intensity increased. Conclusion Twelve weeks of physical therapy with PRT was not superior to 6 weeks in improving walking distance. Hip fracture-related pain was relatively low and indicated strength testing and training was well tolerated. Clinical Trials Registration Number: NCT01174589

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Exercise therapy is effective at improving short- and long-term mobility, ADL and balance in older patients following hip fracture: a systematic review and meta-analysis

The Journals of Gerontology Series A ◽

10.1093/gerona/glab236 ◽

2021 ◽

Author(s):

Signe Hulsbæk ◽

Carsten Juhl ◽

Alice Røpke ◽

Thomas Bandholm ◽

Morten Tange Kristensen

Keyword(s):

Hip Fracture ◽

Exercise Therapy ◽

Lower Limb ◽

Older Patients ◽

Meta Analysis ◽

Term Effect ◽

Short Term ◽

Short And Long Term ◽

Moderate Effect

Abstract Background A systematic review and meta-analysis was performed to evaluate the short- and long-term effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, and secondly, whether the effect was modified by trial level characteristics such as intervention modality, duration and initiation timepoint. Methods Medline, CENTRAL, Embase, CINAHL and PEDro was searched up-to November 2020. Eligibility criteria was randomized controlled trials investigating the effect of exercise therapy on physical function, independence and wellbeing in older patients following hip fracture, initiated from time of surgery up-to 1-year. Results Forty-nine studies involving 3905 participants showed a small to moderate effect of exercise therapy at short term (end of intervention) on mobility (Standardized mean difference, SMD 0.49, 95%CI 0.22-0.76); Activities of Daily Living (ADL) (SMD 0.31, 95%CI 0.16-0.46); lower limb muscle strength (SMD 0.36, 95%CI 0.13-0.60); balance (SMD 0.34, 95%CI 0.14-0.54). At long term (closest to 1-year), small to moderate effects were found for mobility (SMD 0.74, 95%CI 0.15-1.34); ADL (SMD 0.42, 95%CI 0.23-0.61); balance (SMD 0.50, 95%CI 0.07-0.94) and Health related Quality of Life (HRQoL) (SMD 0.31, 95%CI 0.03-0.59). Certainty of evidence was evaluated using GRADE ranging from moderate to very low, due to study limitation and inconsistency. Conclusion We found low certainty of evidence for a moderate effect of exercise therapy on mobility in older patients following hip fracture at end-of-treatment and follow-up. Further, low evidence was found for small to moderate short-term effect on ADL, lower limb muscle strength and balance.

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