title: Rehabilitation Interventions for Older Individuals With Cognitive Impairment Post-Hip Fracture: A Systematic Review.
abstract: OBJECTIVE
  Currently, most rehabilitation services for individuals who sustain a hip fracture are not designed to meet the complex needs of those who also have cognitive impairment. The goal of this review was to identify current best practices for rehabilitation in long-term care settings and approaches to optimize outcomes among individuals with dementia and other cognitive impairments post-hip fracture.
  
  
  METHODS
  The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was used to guide the review. Five electronic databases, including PubMed, EMBASE, CINAHL (EBSCO), Medline (EBSCO), and PsycINFO (EBSCO), were searched for intervention studies published in English language journals. Studies were eligible if they focused on rehabilitation interventions post-hip fracture among older individuals (≥ 65 years) with cognitive impairment who were living in or transferred to long-term care or postacute/rehabilitation settings post-hip fracture. Studies were excluded if they did not enroll individuals with cognitive impairment, the study was descriptive without any intervention content, or the intervention components were only medication, surgical approach or medical treatment.
  
  
  RESULTS
  A total of 4478 records were identified, 1915 of which were duplicative, 2563 were relevant based on title, and after careful review 7 studies were included. Two included studies were randomized controlled trials, one was a single group pre- and post-test, one a descriptive comparison between those with and without cognitive impairment, one a case controlled matched trial, one a nonequivalent groups trial, and one a case report. The interventions varied between manipulating the type and amount of exercise or testing multifactorial issues including environmental interventions and the use of an interdisciplinary team to address psychosocial factors, medication management, use of assistive devices, and specific preferences or concerns of the individuals.
  
  
  CONCLUSIONS
  The evidence summarized in this review suggests that it is feasible to implement rehabilitation programs focused on individuals with cognitive impairment in postacute care settings. Moreover, there was evidence to suggest that intensive rehabilitation and exercise activities are beneficial, although innovative approaches may be needed to engage individuals with cognitive impairment.
authors.affiliation: Organizational Systems and Adult Health, University of Maryland, School of Nursing, Baltimore, MD. Electronic address: resnick@son.umaryland.edu.
authors.forename: Barbara
authors.initials: B
authors.lastname: Resnick
authors.affiliation: Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beaupre
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Lawrence S. Bloomberg Faculty of Nursing Toronto, Ontario, Canada.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: McGilton
authors.affiliation: Organizational Systems and Adult Health, University of Maryland, School of Nursing, Baltimore, MD.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Galik
authors.affiliation: University of Iowa, Iowa City, IA.
authors.forename: Wen
authors.initials: W
authors.lastname: Liu
authors.affiliation: Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Neuman
authors.affiliation: Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.affiliation: Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Denise
authors.initials: D
authors.lastname: Orwig
authors.affiliation: Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
mesh_terms: D000368:Aged; D060825:Cognitive Dysfunction; D006620:Hip Fractures / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D012046:Rehabilitation / Q000379:methods*
keywords: Hip fracture; cognitive impairment; rehabilitation