title: Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture.
abstract: To determine the contribution of cognitive impairment, prefracture functional impairment, and treatment as predictors of functional status and mobility 6 months after discharge from rehabilitation for older adults with hip fracture.
  
  
  
  Longitudinal.
  
  
  
  Inpatient rehabilitation units of two community hospitals.
  
  
  
  Adults with hip fractures aged 65 and older who were discharged from a rehabilitation unit and had been living in the community before the fracture (N = 133).
  
  
  
  Mini-Mental State Examination (MMSE) score at discharge from rehabilitation was used to identify the presence and severity of cognitive impairment. Outcomes were measured using questions from two subscales of the Functional Independence Measure (Self-Care Function and Functional Mobility) and the New Mobility Scale (NMS). Measurements were made at discharge from a rehabilitation setting and 3 and 6 months after discharge.
  
  
  
  Prefracture functional impairment was associated with worse outcomes throughout the 6 months after discharge and with lower rates of improvement, or in some cases decline, after discharge. Cognitive impairment was associated with worse outcomes throughout the 6 months after discharge but was only weakly associated with lower rates of improvement or decline. The Patient Centered Rehabilitation Model of care targeting persons with cognitive impairment (PCRM-CI) intervention group had higher NMS scores after discharge than a usual care group.
  
  
  
  Although cognitive impairment and prefracture functional impairment contribute to poor outcomes, prefracture functional impairment was more strongly associated with poor outcomes than cognitive impairment. There is evidence to show that individuals with cognitive impairment are able to regain their mobility, which suggests a need for postdischarge targeted interventions that include a focus on activities of daily living for older adults with cognitive impairment and functional impairment to stabilize gains from inpatient rehabilitation.
authors.affiliation: Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario.
authors.forename: Katherine S
authors.initials: KS
authors.lastname: McGilton
authors.affiliation: Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.|Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario.
authors.forename: Charlene H
authors.identifier: 0000-0002-0333-7210
authors.initials: CH
authors.lastname: Chu
authors.affiliation: Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.|Department of Medicine, University of Toronto, Toronto, Ontario.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.|Rotman Research Institute, Baycrest Health Sciences, Toronto, Ontario.
authors.forename: Gary
authors.initials: G
authors.lastname: Naglie
authors.affiliation: Department of Kinesiology, University of Windsor, Windsor, Ontario.
authors.forename: Paula M
authors.initials: PM
authors.lastname: van Wyk
authors.affiliation: Department of Research, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario.
authors.forename: Steven
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.|Division of Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario.|Department of and Physical Therapy, University of Toronto, Toronto, Ontario.|Rehabilitation Science Institute, University of Toronto, Toronto, Ontario.
authors.forename: Aileen M
authors.initials: AM
authors.lastname: Davis
mesh_terms: D000203:Activities of Daily Living / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D060825:Cognitive Dysfunction / Q000150:complications / Q000534:rehabilitation; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D051346:Mobility Limitation; D009864:Ontario; D063868:Patient Outcome Assessment; D011446:Prospective Studies; D012307:Risk Factors
keywords: cognitive impairment; dementia, rehabilitation models of care; hip fracture; long-term rehabilitation outcomes; person-centered models of care