title: Survival benefits of post-acute care for older patients with hip fractures in Taiwan: A 5-year prospective cohort study.
abstract: OBJECTIVE
  To evaluate the survival benefits of different models of post-acute care (PAC) services for older patients with hip fractures in Taiwan
  
  
  METHODS
  This was a prospective cohort study that recruited elderly patients with hip fractures receiving surgical treatment from 2007 to 2009 for study. All patients were provided home-based PAC, institution-based PAC or conventional home care (CHC) based on their capacity of family care resources. Functional status and survival status was followed for 4 years.
  
  
  RESULTS
  Overall, 453 hip fracture patients (mean age 81.9 ± 6.8 years, 58.8% men) were recruited for the present study. Among them, 29.4% (133/453) patients received home-based PAC, 25.6% (116/453) patients received institution-based PAC and 45.0% (204/453) received CHC. During follow up, 28.9% (131/453) died within the mean of 940.3 ± 453.40 days. Adjusted for age, sex, living status, visual acuity, mood status, previous fall history, and prefracture activities of daily living (ADL) and instrumental activities of daily living (IADL), ADL fully recovered patients were significantly more likely to survive in the 4-year follow up (HR 2.791, P = 0.01, 95% CI 1.261-6.149). Patients receiving either home- or institution-based PAC had better survival than the CHC group after adjustment for age, sex, living status, visual acuity, mood status, previous fall history, prefracture ADL and IADL (HR 0.486, P = 0.008, 95% CI 0.284-0.832 for home-based PAC; HR 0.546, P = 0.036, 95% CI 0.311-0.960 for institution-based PAC).
  
  
  CONCLUSIONS
  PAC services were of great survival benefit for elderly hip fracture patients, and the home-based model was more likely to achieve complete functional recovery, which was important for long-term survival.
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.|Institute of Public Health, National Yang Ming University, Taipei, Taiwan.
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.affiliation: Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
authors.forename: Cheng-Fong
authors.initials: CF
authors.lastname: Chen
authors.affiliation: Department of Orthopedics, Taipei Veterans General Hospital, Taipei, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
authors.forename: Ching-Kuei
authors.initials: CK
authors.lastname: Huang
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.|Department of Family Medicine, Taipei Veterans General Hospital Yuanshan Branch, Yi-Land, Taiwan.
authors.forename: Wei-Ju
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.|Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006699:Home Care Services; D006801:Humans; D008297:Male; D011446:Prospective Studies; D020127:Recovery of Function; D019467:Subacute Care; D015996:Survival Rate; D013624:Taiwan; D013997:Time Factors; D016896:Treatment Outcome
keywords: hip fracture; home care; institute care; osteoporosis; post-acute care