Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Abstract

To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture. Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6 +/- 7.2 years, Mini Mental State Examination (MMSE) score 11.25 +/- 5.9), 23 with possible cognitive impairment (age 83.9 +/- 6.8 years, MMSE 22.65 +/- 1.6) and 10 without cognitive impairment (age 77.6 +/- 7.4 years, MMSE 29.5 +/- 0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain (admission FIM minus discharge FIM), relative (to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA). Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted (age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p < 0.03). However, the functional gain related to baseline functional status (ANCOVA) was not significantly different between the groups. In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.