BMJ 2000;321:1107-1111 ( 4 November )

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Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia

Tiina M Huusko, internist and geriatrician, ^a Pertti Karppi, head of geriatric division, ^a Veikko Avikainen, head of orthopedic and trauma surgery, ^b Hannu Kautiainen, biostatistical expert, ^c Raimo Sulkava, professor of geriatrics. ^d

^a Department of Rehabilitation, Division of Geriatrics, Central Hospital of Central Finland, 40930 Kinkomaa, Finland, ^b Department of Orthopaedic and Trauma Surgery, Central Hospital of Central Finland, 40620 Jyväskylä, Finland, ^c Rheumatism Foundation Hospital, 18120 Heinola, Finland, ^d Department of Public Health and General Practice, Division of Geriatrics, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland

Correspondence to: T M Huusko, Department of Public Health and General Practice, University of Kuopio, PO Box 1627, 70211 Kuopio, Finland Tiina.Huusko{at}uku.fi

Objective: To evaluate the effect of intensive geriatric rehabilitation on demented patients with hip fracture.
Design: Preplanned subanalysis of randomised intervention study.
Settting: Jyväskylä Central Hospital, Finland.
Participants: 243 independently living patients aged 65 years or older admitted to hospital with hip fracture.
Intervention: After surgery patients in the intervention group (n=120) were referred to the geriatric ward whereas those in the control group were discharged to local hospitals.
Main outcome measures: Length of hospital stay, mortality, and place of residence three months and one year after surgery for hip fracture.
Results: The median length of hospital stay of hip fracture patients with moderate dementia (mini mental state examination score 12-17) was 47 days in the intervention group (n=24) and 147 days in the control group (n=12, P=0.04). The corresponding figures for patients with mild dementia (score 18-23) were 29 days in the intervention group (n=35) and 46.5 days in the control group (n=42, P=0.002). Three months after the operation, in the intervention group 91% (32) of the patients with mild dementia and 63% (15) of the patients with moderate dementia were living independently. In the control group, the corresponding figures were 67% (28) and 17% (2). There were no significant differences in mortality or in the lengths of hospital stay of severely demented patients and patients with normal mini mental state examination scores.
Conclusions: Hip fracture patients with mild or moderate dementia can often return to the community if they are provided with active geriatric rehabilitation.

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