Strong evidence supports use of an interdisciplinary care program in those patients with mild to moderate dementia who have sustained a hip fracture to improve functional outcomes.

Management of Hip Fractures in the Elderly
Endorsed by: OTA, AGS, AAPM&R, ASBMR, USBJI, The Hip Society, AACE, ORA
Strong Evidence STRONG EVIDENCE
Rationale
Two high strength (Berggren et al133 and Marcantonio et al 134), and seven moderate strength (Huusko et al 135; Huusko et al 136; Krichbaum et al 137; Shyu et al138-140; Stenvall et al 141), studies found that an interdisciplinary rehabilitative program achieved better functional outcomes and fall prevention in post-surgical hip fracture patients. The most differences were found in the group of patients having mild to moderate dementia (Huusko et al 135; and Shyu et al 138-140).

The elements of the interdisciplinary rehabilitative programs varied minimally in the studies reviewed. For example, Shyu et al’s study140 included geriatric consultation, rehabilitative services, discharge planning and post-hospital services, while Berggren et al’s 133 study included geriatric assessment, rehabilitation and active detection, prevention and treatment of fall risk factors.

Risks and Harms of Implementing these Recommendations
The delivery and implementation of this therapy vary, but the benefits of rehabilitative services are demonstrated in a variety of settings and across the continuum of care. There is no harm associated with implementing this recommendation.
 
Future Research
Further studies to establish more precise dosages and durations of rehabilitative therapies, as well as to determine the most appropriate settings would be beneficial. Further nutritional research needs to elucidate which type of protein supplementation is most beneficial and should clarify risks associated with malnutrition and benefits of supplementation, especially in diabetic patients.  
  1. (133) Berggren M, Stenvall M, Olofsson B, Gustafson Y. Evaluation of a fall-prevention program in older people after femoral neck fracture: a one-year follow-up. Osteoporos Int 2008;19(6):801-809.
  2. (134) Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc 2001;49(5):516-522.
  3. (135) Huusko TM, Karppi P, Avikainen V, Kautiainen H, Sulkava R. Intensive geriatric rehabilitation of hip fracture patients: a randomized, controlled trial. Acta Orthop Scand 2002;73(4):425-431.
  4. (136) Huusko 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(7269):1107-1111.
  5. (137) Krichbaum K. GAPN postacute care coordination improves hip fracture outcomes. West J Nurs Res 2007;29(5):523-544.
  6. (138) Shyu YI, Liang J, Wu CC et al. Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci 2008;63(1):92-97.
  7. (139) Shyu YI, Liang J, Wu CC et al. Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese. J Am Geriatr Soc 2010;58(6):1081-1089.
  8. (140) Shyu YI, Liang J, Tseng MY et al. Comprehensive Care Improves Health Outcomes Among Elderly Taiwanese Patients With Hip Fracture. J Gerontol A Biol Sci Med Sci 2012.
  9. (141) Stenvall M, Olofsson B, Lundstrom M et al. A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporos Int 2007;18(2):167-175.