title: Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study.
abstract: OBJECTIVE
  To evaluate the association between dementia and postoperative outcomes of older adults with hip fractures.
  
  
  METHODS
  Population-based, retrospective cohort study.
  
  
  METHODS
  Province of Ontario, Canada.
  
  
  METHODS
  All individuals with hip fractures who underwent hip fracture surgery in Ontario, Canada between April 1, 2003 and March 31, 2010 were identified. Physician-diagnosed dementia, prior to hip fracture, was identified using a diagnostic algorithm in the administrative databases.
  
  
  METHODS
  The preoperative characteristics of older adults with and without dementia were compared separately for individuals admitted to hospital from community or long-term care (LTC). Multivariable regression was used to compare postoperative health service utilization, time with LTC admission, and mortality for individuals with and without dementia.
  
  
  RESULTS
  A total of 45,602 older adults had hip fractures and individuals with dementia accounted for 23.9% and 83.5% of all hip fractures from the community and LTC settings, respectively. Compared with those without dementia, individuals with dementia were less likely to be admitted to rehabilitation facilities. Among community-dwelling older adults, dementia was associated with an increased risk of LTC admission [hazard ratio (HR) = 2.49, 95% confidence interval (CI): 2.38-2.61, P < .0001]. Dementia was also associated with a higher mortality for older adults from community (HR = 1.47, 95% CI: 1.41-1.52, P < .0001) and LTC (HR = 1.10; 95% CI: 1.02-1.18, P = .005) settings.
  
  
  CONCLUSIONS
  Dementia is common among older adults with hip fractures and associated with poor prognosis following hip fracture surgery. Specialized services targeting the growing number of older adults with dementia may help to prevent hip fractures and optimize postoperative care for this vulnerable population.
authors: Department of Psychiatry, Queen's University, Kingston, Ontario, Canada. Electronic address: seitzd@providencecare.ca.
authors: Dallas P
authors: DP
authors: Seitz
authors: Department of Medicine, Queen's University, Kingston, Ontario, Canada; Institute for Clinical Evaluative Sciences, Queen's University, Kingston, Ontario, Canada.
authors: Sudeep S
authors: SS
authors: Gill
authors: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Andrea
authors: A
authors: Gruneir
authors: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Peter C
authors: PC
authors: Austin
authors: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Geoffrey M
authors: GM
authors: Anderson
authors: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Department of Medicine, Mt. Sinai Hospital, Toronto, Ontario, Canada.
authors: Chaim M
authors: CM
authors: Bell
authors: Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors: Paula A
authors: PA
authors: Rochon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications*; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009864:Ontario; D011182:Postoperative Care; D011183:Postoperative Complications / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Alzheimer's disease; dementia; health services; hip fracture; surgery