Dementia and injury rehabilitation

The impact of dementia on access to and outcomes from rehabilitation following fracture-related hospitalisation

Project members - Macquarie University

Rebecca Mitchell Associate Professor

Project main description

Whilst the presence of dementia is likely to have a direct impact on outcome from an acute health event in an older person, there are a number of points in the acute and rehabilitation journey following a fracture-related hospitalisation where opportunities exist to improve care, maximise meaningful functional outcomes and reduce the risk of future falls and fractures in this high risk population.

This is a mixed methods study that will examine linked hospitalisation and subacute non-acute patient data for injured dementia and non-dementia suffers to quantify the access of individuals with dementia and lower limb fractures to rehabilitation services and their health outcomes. Interviews will be conducted with both the patient’s (i) referring team into rehabilitation and (ii) their rehabilitation team to examine views on decisions to refer and accept a patient with dementia for injury rehabilitation.  This research will provide the necessary information to inform and shape the design of a future trial which will look at a tailored multidisciplinary intervention to maximise function outcomes following injury-related hospitalisation in older people with dementia.

The study found that compared to individuals aged 65 years and older without dementia, individuals with dementia had 4.3 times (95%CI 3.90-4.78) lower odds of receiving hospital-based rehabilitation. However, when they did receive rehabilitation they achieved significant motor functional gain at discharge compared to admission using the Functional Independence Measure, but to a lesser extent than individuals without dementia.

Publications

• Mitchell R, Draper B, Brodaty H, Close J, Ting HP, Lystad R et al. (2020) An 11-year review of hip fracture hospitalisations, health outcomes, and predictors of access to in-hospital rehabilitation for adults ≥ 65 years living with and without dementia: a population-based cohort study. Osteoporosis International, 31(3):465-474.
• Mitchell R, Fajardo Pulido D, Ryder T, Norton G, Brodaty H, Draper B et al. (2019) Access to rehabilitation services for older adults living with dementia or in a residential aged care facility following a hip fracture: healthcare professionals’ views. Disability and Rehabilitation.1-12
• Mitchell R.  Harvey L. Brodaty H. Draper B. Close J. (2016) Hip fracture and the influence of dementia on health outcomes and access to rehabilitation. Disability and Rehabilitation 38(23) 2286-2295.
• Mitchell R. Harvey L. Brodaty H. Draper B. Close J.  (2017) One-year mortality after hip fracture in older individuals: the effects of delirium and dementia. Archives of Gerontology and Geriatrics 72, 135-141.

Project sponsors

Dementia Collaborative Research Centres

Collaborators

• Assistant Professor Stephen Isbel (Joint Project Lead)
  Faculty of Health, University of Canberra
• Associate Professor Maggie Jamieson
  Faculty of Health, University of Canberra
• Dr Lara Harvey
  Falls and Injury Prevention Group, Neuroscience Research Australia
• Associate Professor Jennie Scarvell
  Faculty of Health, University of Canberra
• Professor Jacqui Close
  Falls and Injury Prevention Group, Neuroscience Research Australia
• Professor Diane Gibson
  Faculty of Health, University of Canberra
• Professor Paul Smith
  Canberra Hospital
• Professor Brian Draper
  School of Psychiatry, University of New South Wales
• Professor Henry Brodaty
  School of Psychiatry, University of New South Wales
• Mr Lennon Wicks
  Faculty of Health, University of Canberra

Related projects

Dementia and injury-related hospitalisations

Dementia and residential aged care

Project status

Completed

Centres related to this project

Centre for Healthcare Resilience and Implementation Science