title: A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia--subgroup analyses of a randomized controlled trial.
abstract: BACKGROUND
  People with cognitive impairment and dementia have a poor outcome after a hip fracture surgery, about 30-50% of all those who sustain a hip fracture have dementia. Therefore the aim was to investigate whether a multidisciplinary postoperative intervention program could reduce postoperative complications and improve functional recovery among people with dementia.
  
  
  METHODS
  A randomized controlled trial with subgroup analyses among patients with dementia. Sixty-four patients with femoral neck fracture, aged ≥70 years at Umeå University Hospital, Sweden. The intervention consisted of staff education, individualized care planning and rehabilitation, active prevention, detection and treatment of postoperative complications, especially delirium. The staff worked in teams to apply comprehensive geriatric assessment, management and rehabilitation, including a follow-up at 4 months postoperatively. The control group followed conventional postoperative routines.
  
  
  RESULTS
  There were fewer postoperative complications in the intervention group such as urinary tract infections, p=0.001; nutritional problems, p=0.025; postoperative delirium, p=0.002; falls, p=0.006. At 4 months a larger proportion in the intervention group had regained their previous independent indoor walking ability performance, p=0.005. At 12 months a larger proportion in the intervention group had regained the activities of daily living (ADL) performance level they had before the fracture, p=0.027.
  
  
  CONCLUSIONS
  This study demonstrates that patients with dementia who suffer a hip fracture can benefit from multidisciplinary geriatric assessment and rehabilitation and should not be excluded from rehabilitation programs.
authors.affiliation: Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden. michael.stenvall@germed.umu.se
authors.forename: Michael
authors.initials: M
authors.lastname: Stenvall
authors.forename: Monica
authors.initials: M
authors.lastname: Berggren
authors.forename: Maria
authors.initials: M
authors.lastname: Lundström
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
authors.forename: Birgitta
authors.initials: B
authors.lastname: Olofsson
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003693:Delirium / Q000517:prevention & control; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009748:Nutrition Disorders / Q000517:prevention & control; D010348:Patient Care Team; D011183:Postoperative Complications / Q000517:prevention & control / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000517:prevention & control; D016138:Walking / Q000706:statistics & numerical data