Does depression, apathy or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip fracture patients?
OBJECTIVE
Depression, apathy (amotivation) and cognitive impairment are common comorbidities in hip fracture patients, which may adversely affect functional outcome of rehabilitation. We examined whether postfracture measures of mood, motivation or cognition are associated with rehabilitation outcome (defined as functional improvement) in inpatient rehabilitation facilities (IRFs), as compared to skilled nursing facilities (SNFs).


METHODS
This prospective study examined elderly patients who received surgical fixation for hip fracture and then received post-acute rehabilitation at an IRF or an SNF. Subjects were characterized at baseline for depression using the Hamilton Rating Scale for Depression, apathy/amotivation using the Apathy Evaluation Scale and mild-moderate cognitive impairment using the Mini-Mental Status Examination. Functional recovery was measured over 12-week follow-up using the Functional Independence Measure.


RESULTS
Fifty-eight subjects were discharged from acute care to an IRF and 39 to an SNF. Patients with depression, apathy or cognitive impairment who received rehabilitation at an IRF had significantly better functional outcomes than similarly impaired patients at SNFs, and similar outcomes such as nondepressed, motivated and cognitively intact elderly at IRFs.


CONCLUSIONS
These findings suggest that depression, amotivation or mild-moderate cognitive impairment after hip fracture do not reduce the benefit of post-acute rehabilitation in an IRF.
Lenze
Eric J
EJ
Department of Psychiatry, University of Pittsburgh School of Medicine, Advanced Center for Interventions and Services Research in Late Life Mood Disorders and John A. Hartford Center of Excellence in Geriatric Psychiatry, PA 15213, USA. lenzeej@upmc.edu
Skidmore
Elizabeth R
ER
Dew
Mary Amanda
MA
Butters
Meryl A
MA
Rogers
Joan C
JC
Begley
Amy
A
Reynolds
Charles F
CF
Munin
Michael C
MC
D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology / Q000534:rehabilitation / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits / Q000706:statistics & numerical data*; D008297:Male; D015995:Prevalence; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data