Health  Vol.7 No.9 , September 2015
Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms
ABSTRACT
Aim: Hip fracture implies severe problems to older people; special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved; 70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

Cite this paper
Colombo, M. , Vitali, S. , Cutaia, C. , Marelli, E. and Guaita, A. (2015) Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms. Health, 7, 1175-1182. doi: 10.4236/health.2015.79132.
References
[1]   Salkeld, G., Cameron, I.D., Cumming, R.G., Easter, S., Seymour, J., Kurlle, S.E., et al. (2000) Quality of Life Related to Fear of Falling and Hip Fracture in Older Women: A Time Trade off Study. British Medical Journal, 320, 341-345.
http://dx.doi.org/10.1136/bmj.320.7231.341

[2]   Young, Y., Brant, L., German, P., Kenzora, J. and Magaziner, J. (1997) Longitudinal Examination of Functional Recovery among Older People with Subcapital Hip Fractures. Journal of the American Geriatrics Society, 45, 288-294.
http://dx.doi.org/10.1111/j.1532-5415.1997.tb00942.x

[3]   Magaziner, J., Hawkes, W., Hebel, J.R., Zimmerman, S.I., Fox, K.M., Dolan, M., et al. (2000) Recovery from Hip Fracture in Eight Areas of Function. Journal of Gerontology A Biological Sciences Medical Sciences, 55, M498-M507.
http://dx.doi.org/10.1093/gerona/55.9.m498

[4]   Piscitelli, P., Iolascon, G., Argentiero A., Chitano, G., Neglia, C., Marcucci, G., et al. (2012) Incidence and Costs of Hip Fractures vs Strokes and Acute Myocardial Infarction in Italy: Comparative Analysis Based on National Hospitalization Records. Clinical Interventions in Aging, 7, 575-583.
http://dx.doi.org/10.2147/CIA.S36828

[5]   Schuman, J.E., Beattie, E.J., Steed, D.A., Merry, G.M. and Kraus, A.S. (1981) Geriatric Patients with and without Intellectual Dysfunctions: Effectiveness of a Standard Rehabilitation Program. Archives of Physical Medicine and Rehabilitation, 62, 612-618.

[6]   Baker, B.R., Duckworth, T. and Wilkes, E. (1978) Mental State and Other Prognostic Factors in Femoral Fractures in the Elderly. The Journal of the Royal College of General Practitioners, 28, 557-559.

[7]   Billig, N., Ahmed, S.W. and Kenmore, P.I. (1988) Approaches to Senior Care # 1. Hip Fracture, Depression, and Cognitive Impairment: A Follow-Up Study. Orthopaedic Review, 17, 315-320.

[8]   Hershkovitz, A., Jacubovski, O.S., Alima Bot, M., Oshry, V. and Brill, S. (2010) Clock Drawing and Rehabilitation Outcome in Hip Fracture Patients. Disability and Rehabilitation, 32, 2013-2017.
http://dx.doi.org/10.3109/09638288.2010.482175

[9]   Reuling, E.M.B.P., Sierevelt, I.N., van dem Bekerom M.P.J., Hilverdink, E.F., Schnater, J.N., van Dijk, C.N., et al. (2012) Predictors of Functional Outcome Following Femoral Neck Fractures Treated with an Arthroplasty: Limitations of the Harris Hip Score. Archives of Orthopaedic and Trauma Surgery, 132, 249-256.
http://dx.doi.org/10.1007/s00402-011-1424-0

[10]   Jette, A.M., Harris, B.A., Cleary, P.D. and Campion, E.W. (1987) Functional Recovery after Hip Fractures. Archives of Physical Medicine and Rehabilitation, 68, 735-740.

[11]   Barnes, B. (1984) Ambulation Outcomes after Hip Fractures. Physical Therapy, 64, 317-320.

[12]   Goldstein, F.C., Strasser, D.C., Woodaed, J.L. and Roberts, V.J. (1997) Functional Outcome of Cognitively Impaired Hip Fracture Patients on a Geriatric Rehabilitation Unit. Journal of the American Geriatrics Society, 45, 35-42.
http://dx.doi.org/10.1111/j.1532-5415.1997.tb00975.x

[13]   Heruti, R.J., Lusky, A., Barell, V., Ohry, A. and Adunsky, A. (1999) Cognitive Status at Admission: Does It Affect the Rehabilitation Outcome of Elderly Patients with Hip Fracture? Archives of Physical Medicine and Rehabilitation, 80, 432-436.
http://dx.doi.org/10.1016/S0003-9993(99)90281-2

[14]   Huusko, T.M., Karppi, P., Avikainen, V., Kautiainen, H. and Sulkava, R. (2000) Randomised, Clinically Controlled Trial of Intensive Geriatric Rehabilitation in Patients with Hip Fracture: Subgroup of Patients with Dementia. British Medical Journal, 321, 1107-1111.
http://dx.doi.org/10.1136/bmj.321.7269.1107

[15]   Bellelli, G., Frisoni, G.B., Pagani, M., Magnifico, F. and Trabucchi, M. (2007) Does Cognitive Performance Affect Physical Therapy Regimen after Hip Fracture Surgery? Aging Clinical and Experimental Research, 19, 119-124.
http://dx.doi.org/10.1007/BF03324677

[16]   Guaita, A. and Jones, M. (2011) A Prosthetic Approach for Individuals with Dementia? JAMA: The Journal of the American Medical Association, 305, 402-403.
http://dx.doi.org/10.1001/jama.2011.28

[17]   Bellelli, G., Frisoni, G.B., Bianchetti, A., Boffelli, S., Guerrini, G.B., Scotuzzi, A., et al. (1998) Special Care Units for Demented Patients: A Multicenter Study. The Gerontologist, 38, 456-462.
http://dx.doi.org/10.1093/geront/38.4.456

[18]   Nobili, A., Piana, I., Balossi, L., Pasina, L., Matucci, M., Tarantola, M., Trevisan, S., et al. (2008) Alzheimer Special Care Units Compared with Traditional Nursing Home for Dementia Care: Are There Differences at Admission and in Clinical Outcomes? Alzheimer Disease and Associated Disorders, 22, 352-361.
http://dx.doi.org/10.1097/WAD.0b013e31818207d0

[19]   Folstein, M.F., Folstein, S.E. and McHugh, P.R. (1975) Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients for the Clinician. Journal of Psychiatric Research, 12, 189-198.
http://dx.doi.org/10.1016/0022-3956(75)90026-6

[20]   Morris, J.C. (1993) The Clinical Dementia Rating (CDR): Current Version and Scoring Rules. Neurology, 43, 2412- 2414.
http://dx.doi.org/10.1212/WNL.43.11.2412-a

[21]   Reisberg, B., Ferris, S.H., De Leon, M.J. and Crook, T. (1982) The Global Deterioration Scale for Assessment of Primary Degenerative Dementia. The American Journal of Psychiatry, 139, 1136-1139.
http://dx.doi.org/10.1176/ajp.139.9.1136

[22]   Shah, S., Vanclay, F. and Cooper, B. (1989) Improving the Sensitivity of the Barthel Index for Stroke Rehabilitation. Journal of Clinical Epidemiology, 42, 703-709.
http://dx.doi.org/10.1016/0895-4356(89)90065-6

[23]   Tinetti, M.E. (1986) Performance-Oriented Assessment of Mobility Problems in Elderly Patients. Journal of the American Geriatrics Society, 34, 119-126.
http://dx.doi.org/10.1111/j.1532-5415.1986.tb05480.x

[24]   Bellelli, G., Frisoni, G.B., Bianchetti, A. and Trabucchi, M. (1997) The Bedford Alzheimer Nursing Severity Scale for the Severely Demented: Validation Study. Alzheimer Disease and Associated Disorders, 11, 71-77.
http://dx.doi.org/10.1097/00002093-199706000-00003

[25]   Cummings, J.L., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D.A. and Gornbein, J. (1994) The Neuropsychiatric Inventory: Comprehensive Assessment of Psychopathology in Dementia. Neurology, 44, 2308-2314.
http://dx.doi.org/10.1212/WNL.44.12.2308

[26]   Parmalee, P.A., Thuras, P.D., Katz, I.R. and Lawton, M.P. (1995) Validation of the Cumulative Illness Rating Scale in a Geriatric Residential Population. Journal of the American Geriatrics Society, 43, 130-137.
http://dx.doi.org/10.1111/j.1532-5415.1995.tb06377.x

[27]   Colombo, M., Vitali, S., Cairati M., Vaccaro, R., Andreoni, G. and Guaita, A. (2007) Behavioural and Psychotic Symptoms of Dementia Improvements in a Special Care Unit: A Factor Analysis. Archives of Gerontology and Geriatrics, 44, 113-120.
http://dx.doi.org/10.1016/j.archger.2007.01.017

[28]   Rizzo, M. and Nawrot, M. (1998) Perception of Movement and Shape in Alzheimer’s Disease. Brain, 121, 2259-2270.
http://dx.doi.org/10.1093/brain/121.12.2259

[29]   Kavcic, V. and Duffy, C.J. (2003) Attentional Dynamics and Visual Perception: Mechanisms of Spatial Disorientation in Alzheimer’s Disease. Brain, 126, 1173-1181.
http://dx.doi.org/10.1093/brain/awg105

[30]   Baddeley, A.D., Baddeley, H.A., Bucks, R.S. and Wilcock, G.K. (2001) Attentional Control in Alheimer’s Disease. Brain, 124, 1492-1508.
http://dx.doi.org/10.1093/brain/124.8.1492

[31]   Sheridan, P.L., Solomont, J., Kowall, N. and Hausdorff, J.M. (2003) Influence of Executive Function on Locomotor Function: Divided Attention Increases Gait Variability in Alzheimer’s Disease. Journal of the American Geriatrics Society, 51, 1633-1637.
http://dx.doi.org/10.1046/j.1532-5415.2003.51516.x

[32]   Kluger, A., Gianutsos, J.G., Golomb, J., Ferris, S.H., George, A.E., Franssen, E., et al. (1997) Patterns of Motor Impairment in Normal Aging, Mild Cognitive Decline, and Early Alzheimer’s Disease. Journal of Gerontology B Psychological Sciences Social Sciences, 52, P28-P39.
http://dx.doi.org/10.1093/geronb/52B.1.P28

[33]   Montero-Odasso, M., Muir, S.W. and Speechley, M. (2012) Dual-Task Complexity Affects Gait in People with Mild Cognitive Impairment: The Interplay between Gait Variability, Dual Tasking, and Risk of Falls. Archives of Physical Medicine and Rehabilitation, 93, 293-299.
http://dx.doi.org/10.1016/j.apmr.2011.08.026

[34]   Kearns, W.D. (2010) Elder Path Tortuosity Covaries with MMSE Geographical Orientation Subscale. Gerontechnology, 9, 176-177.
http://dx.doi.org/10.4017/gt.2010.09.02.020.00

[35]   Kearns, W.D. (2010) Of Falls and Fractals: My Career with My Mentor, Colleague and Friend, Professor James L. Fozard. Gerontechnology, 9, 388-396.
http://dx.doi.org/10.4017/gt.2010.09.03.010.00

[36]   Orcioli-Silva, D., Simieli, L., Barbieri, F.A., Stella, F. and Gobbi, L.T. (2012) Adaptive Walking in Alzheimer’s Disease. International Journal of Alzheimer’s Disease, 2012, Article ID: 674589.

[37]   Marottoli, R.A., Berkman, L.F. and Cooney, L.M. (1992) Decline in Physical Function Following Hip Fracture. Journal of the American Geriatrics Society, 40, 861-866.
http://dx.doi.org/10.1111/j.1532-5415.1992.tb01980.x

[38]   Dubljanin-Raspopovic, E., Markovic-Denic, L., Matanovic, D., Grajic, M., Krstic, N. and Bumbasirevic, M. (2012) Is Pre-Fracture Functional Status Better than Cognitive Level in Predicting Short-Term Outcome of Elderly Hip Fracture Patients? Archives of Medical Sciences, 8, 115-122.
http://dx.doi.org/10.5114/aoms.2012.27291

[39]   Hakkinen, A., Heinonen, M., Kautiainen, H., Huusko, T., Sulkava, R. and Karppi, P. (2007) Effect of Cognitive Impairment on Basic Activities of Daily Living in Hip Fracture Patients: A 1-Year Follow-Up. Aging Clinical and Experimental Research, 19, 139-144.
http://dx.doi.org/10.1007/BF03324680

[40]   Hershkovitz, A., Kalandariov, Z., Hermush, V., Weiss, R. and Brill, S. (2007) Factors Affecting Short-Term Rehabilitation Outcomes of Disabled Elderly Patients with Proximal Hip Fracture. Archives of Physical Medicine and Rehabilitation, 88, 916-921.
http://dx.doi.org/10.1016/j.apmr.2007.03.029

[41]   Ghisla, M.K., Cossi, S., Timpini, A., Baroni, F., Facchi, E. and Marengoni, A. (2007) Predictors of Successful Rehabilitation in Geriatric Patients: Subgroup Analysis of Patients with Cognitive Impairment. Aging Clinical and Experimental Research, 19, 417-423.
http://dx.doi.org/10.1007/BF03324724

[42]   Colombo, M. and Vitali, S. (1998) Nutritional Problems in Demented Elderly. Studies in Health Technology and Informatics, 48, 266-268.

[43]   Beloosesky, Y., Grinblat, J., Epelboym, B., Weiss, A., Grosman, B. and Hendel, D. (2002) Functional Gain of Hip Fracture Patients in Different Cognitive and Functional Groups. Clinical Rehabilitation, 16, 321-328.
http://dx.doi.org/10.1191/0269215502cr497oa

[44]   Morghen, S., Gentile, S., Ricci, E., Guerini, F., Bellelli, G. and Trabucchi, M. (2011) Rehabilitation of Older Adults with Hip Fracture: Cognitive Function and Walking Abilities. Journal of the American Geriatrics Society, 59, 1497-1502.
http://dx.doi.org/10.1111/j.1532-5415.2011.03496.x

[45]   Allen, J., Koziak, A., Buddingh, S., Liang, J., Buckingham, J. and Beaupre, L.A. (2012) Rehabilitation in Patients with Dementia Following Hip Fracture: A Systematic Review. Physiotherapy Canada, 64, 192-201.
http://dx.doi.org/10.3138/ptc.2011-06BH

[46]   Colombo, M., Guaita, A., Cottino, M., Previderè, G., Ferrari, D. and Vitali, S. (1994) The Impact of Cognitive Impairment on the Rehabilitation Process in Geriatrics. Archives of Gerontology and Geriatrics. Supplement, 9, 85-92.

[47]   Lenze, E.J., Skidmore, E.R., Dew, M.A., Butters, M.A., Rogers, J.C., Begley, A., et al. (2007) Does Depression, Apathy or Cognitive Impairment Reduce the Benefit of Inpatient Rehabilitation Facilities for Elderly Hip Fracture Patients? General Hospital Psychiatry, 29, 141-146.
http://dx.doi.org/10.1016/j.genhosppsych.2007.01.001

[48]   Eriksson, S., Gustafson, Y. and Lundin-Olsson, L. (2007) Characteristics Associated with Falls in Patients with Dementia in a Psychogeriatric Ward. Aging Clinical and Experimental Research, 19, 97-103.
http://dx.doi.org/10.1007/BF03324674

[49]   Taniguchi, S., Narumoto, J., Shibata, K., Ayani, N., Matsuoka, T., Okamura, A., et al. (2013) Treatment in a Ward for Elderly Patients with Dementia in Japan. Neuropsychiatric Disease and Treatment, 9, 357-363.
http://dx.doi.org/10.2147/NDT.S41581

[50]   Sylliaas, H., Selb?k, G. and Bergland, A. (2012) Do Behavioral Disturbances Predict Falls among Nursing Home Residents? Aging Clinical and Experimental Research, 24, 251-256.
http://dx.doi.org/10.1007/BF03325253

 
 
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