Hostname: page-component-54dcc4c588-r5qjk Total loading time: 0 Render date: 2025-10-13T15:20:59.348Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  11 August 2014

Francisco J Tarazona-Santabalbina ,
Juan R Doménech-Pascual ,
Ángel Belenguer-Varea A  and
Eduardo Rovira Daudi
Francisco J Tarazona-Santabalbina*
Affiliation:
Department of Geriatrics, Hospital Universitario de la Ribera, Valencia, Spain
Juan R Doménech-Pascual
Affiliation:
Department of Geriatrics, Hospital Universitario de la Ribera, Valencia, Spain
Ángel Belenguer-Varea A
Affiliation:
Department of Geriatrics, Hospital Universitario de la Ribera, Valencia, Spain
Eduardo Rovira Daudi
Affiliation:
Department of Internal Medicine, Hospital Universitario de la Ribera, Valencia, Spain
*
Address for correspondence: Dr Francisco J. Tarazona-Santabalbina, Servicio de Geriatría, Hospital Universitario de la Ribera, Carretera de Corbera 1, 46600 – Alzira, Valencia, Spain. Email: fjtarazona@hospital-ribera.com
Get access Rights & Permissions [Opens in a new window]

Summary

Hip 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.

Keywords

hip fracturedementiageriatric assessmentfunctional recoverymortality

Information

Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 3 , August 2014 , pp. 219 - 227
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Johnell, O, Kanis, JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporosis Int 2006; 17: 1726–33.CrossRefGoogle ScholarPubMed
2Pasco, JA, Sanders, KM, Hoekstra, FM, Henry, MJ, Nicholson, GC, Kotowicz, MA. The human cost of fracture. Osteoporos Int 2005; 16: 2046–52.CrossRefGoogle ScholarPubMed
3Zuckerman, JD. Hip fracture. N Engl J Med 1996; 334: 1519–25.Google Scholar
4Roche, JJ, Wenn, RT, Sahota, Oet al.Effect of comorbidities and postoperative complications on mortality after hip fracture in elderly people: Prospective observational cohort study. BMJ 2005; 331: 1374.CrossRefGoogle ScholarPubMed
5Rapp, K, Becker, C, Lamb, SE, Icks, A, Klenk, J. Hip fractures in institutionalized elderly people: incidence rates and excess mortality. J Bone Mineral Res 2008; 23: 1825–31.CrossRefGoogle ScholarPubMed
6Jiang, HX, Majumdar, SR, Dick, DAet al.Development and initial validation of a risk score for predicting in-hospital and 1-year mortality in patients with hip fractures. J Bone Mineral Res 2005; 20: 494–500.Google Scholar
7Abrahamsen, B, van Staa, T, Ariely, R, Olson, M, Cooper, C. Excess mortality following hip fracture: a systematic epidemiological review. Osteoporosis Int 2009; 20: 1633–50.Google Scholar
8Tarazona-Santabalbina, FJ, Belenguer-Varea, A, Rovira-Daudi, Eet al.Early interdisciplinary hospital intervention for elderly patients with hip fractures: functional outcome and mortality. Clinics (Sao Paulo) 2012; 67: 547–56.Google Scholar
9Bentler, SE, Liu, L, Obrizan, M, Cook, EAet al.The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170: 1290–99.CrossRefGoogle ScholarPubMed
10Kanis, JA, Oden, A, Johnell, Oet al.The components of excess mortality after hip fracture. Bone 2003; 32: 468–73.Google Scholar
11Nikkel, LE, Fox, EJ, Black, KPet al.Impact of comorbidities on hospitalization costs following hip fracture. J Bone Joint Surg Am 2012; 94: 9–17.Google Scholar
12Edelstein, DM, Aharonoff, GB, Karp, A, Capla, EL, Zuckerman, JD, Koval, KJ. Effect of postoperative delirium on outcome after hip fracture. Clin Orthop Relat Res 2004; 422: 195–200.CrossRefGoogle Scholar
13Gustafson, Y, Berggren, D, Brännström, Bet al.Acute confusional states in elderly patients treated for femoral neck fracture. J Am Geriatr Soc 1988; 36: 525–30.CrossRefGoogle ScholarPubMed
14Alarcón, T, González-Montalvo, JI. Fractura osteoporótica de cadera. Factores predictivos de recuperación funcional a corto y largo plazo. An Med Interna (Madrid) 2004; 21: 87–96.Google Scholar
15Magaziner, J, Hawkes, W, Hebel, JRet al.Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000; 55A: M498–507.CrossRefGoogle Scholar
16Pressley, JC, Trott, C, Tang, Met al.Dementia in community-dwelling elderly patients: a comparison of survey data, Medicare claims, cognitive screening, reported symptoms and activity limitation. J Clin Epidemiol 2003; 56: 896–905.CrossRefGoogle Scholar
17Sloane, PD, Zimmerman, S, Suchindran, Cet al.The public health impact of Alzheimer's disease, 2000–2050: potential implication of treatment advances. Annu Rev Public Health 2002; 23: 213–31.Google Scholar
18Buchner, DM, Larson, EB. Falls and fractures in patients with Alzheimer-type dementia. JAMA 1987; 257: 1492–95.CrossRefGoogle ScholarPubMed
19Tinetti, ME, Speechley, M, Ginter, SF. Risk factors for falls among elderly persons living in the community. New Engl J Med 1988; 319: 1701–7.Google Scholar
20Matsueda, M, Ishii, Y. The relationship between dementia score and ambulatory level after hip fracture in the elderly. Am J Orthop (Belle Mead NJ) 2000; 29: 691–93.Google Scholar
21Parker, MJ, Palmer, CR. Prediction of rehabilitation after hip fracture. Age Ageing 1995; 24: 96–98.CrossRefGoogle ScholarPubMed
22Schaller, F, Sidelnikov, E, Theiler, Ret al.Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 2012; 51: 347–52.Google Scholar
23Soderqvist, A, Miedel, R, Ponzer, Set al.The influence of cognitive function on outcome after hip fracture. J Bone Joint Surg 2006; 88: 2115–23.Google Scholar
24Givens, JL, Sanft, TB, Marcantonio, ER. Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 2008; 56: 1075–79.Google Scholar
25Tarazona-Santabalbina, FJ, Belenguer-Varea, A, Rovira Daudi, E et al. Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture. Geriatr Gerontol Int 2014 (in press).Google Scholar
26Kyo, T, Takaoka, K, Ono, K. Femoral neck fracture. Clin Orthop 1993; 292: 215–22.CrossRefGoogle Scholar
27Takayama, S, Iki, M, Kusaka, Yet al.Factors that influence functional prognosis in elderly patients with hip fracture. Environ Health Preventive Med 2001; 6: 47–53.Google Scholar
28Devas, M.Fractures in the elderly. Geront Clin 1964; 6: 347–59.CrossRefGoogle ScholarPubMed
29Clark, A, Wainwright, D. Management of the fractured neck of femur in the elderly female. A joint approach of orthopaedic surgery and geriatric medicine. Geront Clin 1966; 8: 321–26.CrossRefGoogle Scholar
30Devas, M.Tratamiento ortopédico del anciano. MSJ, En Pathy (ed), Principios y práctica de la medicina geriatric, pp. 93–107. Madrid, 1990.Google Scholar
31Alarcón, T, González, J, Bárcena, Aet al.Interconsulta geriátrica en el servicio de Traumatología. Beneficios asistenciales. Rev Ortop Traumatol 2002; 46: 534–38.Google Scholar
32González, J, Alarcón, T, Pallardo, Bet al.Ortogeriatría en pacientes agudos (I). Aspectos asistenciales. Rev Esp Geriatr Gerontol 2008; 43: 239–51.Google Scholar
33Wajeman, R, Sheard, P, Jenner, G. Ortho-geriatric liaison: the missing link? J Bone Joint Surg 2004; 86B: 636–38.CrossRefGoogle Scholar
34Cameron, I, Crotty, M, Currie, Cet al.Geriatric rehabilitation following fractures in older people: a systematic review. Health Technol Assess 2000; 4: 1–83.Google Scholar
35Gillespie, W.Extracts for clinical evidence. Hip fracture. BMJ 2000; 321: 968–75.Google Scholar
36Ringdal, GI, Ringdal, K, Juliebø, V, Wyller, TB, Hjermstad, MJ, Loge, JH. Using the Mini-Mental State Examination to screen for delirium in elderly patients with hip fracture. Dement Geriatr Cogn Disord 2011; 32: 394–400.Google Scholar
37Formiga, F, Lopez-Soto, A, Duaso, Eet al.Characteristics of fall-related hip fractures in community-dwelling elderly patients according to cognitive status. Aging Clin Exp Res 2008; 20: 434–38.CrossRefGoogle ScholarPubMed
38Juliebø, V, Bjøro, K, Krogseth, M, Skovlund, E, Ranhoff, AH, Wyller, TB. Risk factors for preoperative and postoperative delirium in elderly patients with hip fracture. J Am Geriatr Soc 2009; 57: 1354–61.CrossRefGoogle ScholarPubMed
39Freter, SH, George, J, Dunbar, MJ, Morrison, M, Macknight, C, Rockwood, K. Prediction of delirium in fractured neck of femur as part of routine preoperative nursing care. Age Ageing 2005; 34: 387–88.CrossRefGoogle ScholarPubMed
40Furlaneto, ME, Garcez-Leme, LE. Delirium in elderly individuals with hip fracture: causes, incidence, prevalence, and risk factors. Clinics (Sao Paulo) 2006; 61: 35–40.Google Scholar
41Chrispal, A, Mathews, KP, Surekha, V. The clinical profile and association of delirium in geriatric patients with hip fractures in a tertiary care hospital in India. J Assoc Physicians India 2010; 58: 15–19.Google Scholar
42Söderqvist, A, Strömberg, L, Ponzer, S, Tidermark, J. Documenting the cognitive status of hip fracture patients using the Short Portable Mental Status Questionnaire. J Clin Nurs 2006; 15: 308–14.Google Scholar
43White, JJ, Khan, WS, Smitham, PJ. Perioperative implications of surgery in elderly patients with hip fractures: an evidence-based review. J Perioper Pract 2011; 21: 192–97.Google ScholarPubMed
44Lundström, M, Olofsson, B, Stenvall, Met al.Postoperative delirium in old patients with femoral neck fracture: a randomized intervention study. Aging Clin Exp Res 2007; 19: 178–86.Google Scholar
45Smith, T, Hameed, Y, Cross, J, Sahota, O, Fox, C. Assessment of people with cognitive impairment and hip fracture: a systematic review and meta-analysis. Arch Gerontol Geriatr 2013; 57: 117–26.Google Scholar
46Deschodt, M, Braes, T, Flamaing, Jet al.Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc 2012; 60: 733–39.Google Scholar
47Morghen, S, Gentile, S, Ricci, E, Guerini, F, Bellelli, G, Trabucchi, M. Rehabilitation of older adults with hip fracture: cognitive function and walking abilities. J Am Geriatr Soc 2011; 59: 1497–502.Google Scholar
48Savino, E, Martini, E, Lauretani, Fet al.Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med 2013; 126: 1068–75.CrossRefGoogle ScholarPubMed
49Oude Voshaar, RC, Banerjee, S, Horan, Met al.Fear of falling more important than pain and depression for functional recovery after surgery for hip fracture in older people. Psychol Med 2006; 36: 1635–45.Google Scholar
50Harboun, M, Dorenlot, P, Cohen, Net al.Impact of hip fracture, heart failure and weight loss on the risk of institutionalization of community-dwelling patients with dementia. Int J Geriatr Psychiatry 2008; 23: 1245–52.Google Scholar
51Hershkovitz, A, Jacubovski, OS, Alima Bot, M, Oshry, V, Brill, S. Clock drawing and rehabilitation outcome in hip fracture patients. Disabil Rehabil 2010; 32: 2113–17.CrossRefGoogle ScholarPubMed
52Muir, SW, Yohannes, AM. The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 2009; 32: 24–32.Google Scholar
53Hershkovitz, A, Polatov, I, Beloosesky, Y, Brill, S. Factors affecting mortality of frail hip-fractured elderly patients. Arch Gerontol Geriatr 2010; 51: 113–16.Google Scholar
54Bellelli, G, Frisoni, GB, Turco, R, Trabucchi, M. Depressive symptoms combined with dementia affect 12-months survival in elderly patients after rehabilitation post-hip fracture surgery. Int J Geriatr Psychiatry 2008; 23: 1073–77.Google Scholar
55Huusko, TM, Karppi, P, Avikainen, V, Kautiainen, H, Sulkava, R. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000; 321: 1107–11.Google Scholar
56Stenvall, M, Berggren, M, Lundström, M, Gustafson, Y, Olofsson, B. A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia-subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr 2012; 54: e284–89.Google Scholar
57Al-Ani, AN, Flodin, L, Söderqvist, Aet al.Does rehabilitation matter in patients with femoral neck fracture and cognitive impairment? A prospective study of 246 patients. Arch Phys Med Rehabil 2010; 91: 51–57.Google Scholar
58Naglie, G, Tansey, C, Kirkland, JLet al.Interdisciplinary in-patient care for elderly people with hip fracture: a randomized controlled trial. CMAJ 2002; 167: 25–32.Google Scholar
59Muir, SW, Yohannes, AM. The impact of cognitive impairment on rehabilitation outcomes in elderly patients admitted with a femoral neck fracture: a systematic review. J Geriatr Phys Ther 2009; 32: 24–32.CrossRefGoogle ScholarPubMed
60Moncada, LV, Andersen, RE, Franckowiak, SC, Christmas, C. The impact of cognitive impairment on short-term outcomes of hip fracture patients. Arch Gerontol Geriatr 2006; 43: 45–52.Google Scholar
61McGilton, KS, Davis, AM, Naglie, Get al.Evaluation of patient-centred rehabilitation model targeting older persons with a hip fracture, including those with cognitive impairment. BMC Geriatr 2013; 13: 136.Google Scholar
62Shyu, YI, Tsai, WC, Chen, MCet al.Two-year effects of an interdisciplinary intervention on recovery following hip fracture in older Taiwanese with cognitive impairment. Int J Geriatr Psychiatry 2012; 27: 529–38.CrossRefGoogle ScholarPubMed
63Allen, J, Koziak, A, Buddingh, S, Liang, J, Buckingham, J, Beaupre, LA. Rehabilitation in patients with dementia following hip fracture: a systematic review. Physiother Can 2012; 64: 190–201.Google Scholar
64Seitz, DP, Gill, SS, Gruneir, Aet al.Effects of dementia on post-operative outcomes of older adults with hip fractures: a population-based study. J Am Med Dir Assoc 2014; 8610: 727–75.Google Scholar
65Schaller, F, Sidelnikov, E, Theiler, Ret al.Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture. Bone 2012; 51: 347–52.Google Scholar
66Prieto-Alhambra, D, Judge, A, Arden, NK, Cooper, C, Lyles, KW, Javaid, MK. Fracture prevention in patients with cognitive impairment presenting with a hip fracture: secondary analysis of data from the HORIZON Recurrent Fracture Trial. Osteoporos Int 2014; 25: 77–83.Google Scholar
67Wyller, TB, Watne, LO, Torbergsen, Aet al.The effect of a pre- and post-operative orthogeriatric service on cognitive function in patients with hip fracture. The protocol of the Oslo Orthogeriatrics Trial. BMC Geriatr 2012; 12: 36.CrossRefGoogle ScholarPubMed
68Piscitelli, P, Metozzi, A, Benvenuti, Eet al.Connections between the outcomes of osteoporotic hip fractures and depression, delirium or dementia in elderly patients: rationale and preliminary data from the CODE study. Clin Cases Miner Bone Metab 2012; 9: 40–44.Google Scholar
69Hebert-Davies, J, Laflamme, GY, Rouleau, D; HEALTH and FAITH investigators. Bias towards dementia: are hip fracture trials excluding too many patients? A systematic review. Injury 2012; 43: 1978–84.Google Scholar
70Bentler, SE, Liu, L, Obrizan, Met al.The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol 2009; 170: 1290–99.Google Scholar
71Hershkovitz, A, Kalandariov, Z, Hermush, Vet al.Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Arch Phys Med Rehabil 2007; 88: 916–21.Google Scholar