title: Rehabilitation of Older Adults with Dementia After Hip Fracture.
abstract: OBJECTIVE
  To evaluate the effects of postoperative rehabilitation on the outcomes of older adults with dementia who experienced hip fracture.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Ontario, Canada.
  
  
  METHODS
  Community-dwelling adults with dementia who underwent hip fracture surgery between 2003 and 2011. Participants were categorized as no rehabilitation, complex continuing care (CCC), home-care based rehabilitation (HCR), and inpatient rehabilitation (IPR).
  
  
  METHODS
  Time to long-term care (LTC) placement, mortality, and risk of repeat hip fracture and falls.
  
  
  RESULTS
  Of 11,200 individuals with dementia who experienced a hip fracture during the study period, 4,494 (40.1%) received no rehabilitation, 2,474 (22.1%) were admitted to CCC, 1,157 (10.3%) received HCR, and 3,075 (27.4%) received IPR. HCR and IPR were associated with less risk of LTC admission after discharge from hospital than no rehabilitation. All three forms of rehabilitation were associated with lower risk of mortality than no rehabilitation, with the greatest effect observed with IPR. HCR was associated with a higher risk of falls than no rehabilitation (P=.03); there were no other significant between-group differences in risk of falls or repeat fractures (P>.05).
  
  
  CONCLUSIONS
  Postfracture rehabilitation for older adults with dementia is associated with lower risk of LTC placement and mortality. Improving access to rehabilitation services for this vulnerable population may improve postfracture outcomes.
authors.affiliation: Department of Psychiatry, Queen's University, Kingston, Ontario, Canada.|Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Dallas P
authors.initials: DP
authors.lastname: Seitz
authors.affiliation: Institute for Clinical Evaluative Sciences Queen's, Kingston, Ontario, Canada.|Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Austin
authors.affiliation: 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.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Anderson
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.|Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gruneir
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|Department of Medicine, University of Toronto, Toronto, Ontario, Canada.|Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
authors.forename: Paula A
authors.initials: PA
authors.lastname: Rochon
mesh_terms: D000369:Aged, 80 and over; D003704:Dementia / Q000150:complications / Q000401:mortality / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation; D006620:Hip Fractures / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011182:Postoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: dementia; health services; hip fracture; nursing home placement; rehabilitation