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Int J Older People Nurs. 2008 Sep;3(3):178-86. doi: 10.1111/j.1748-3743.2008.00131.x.

Hip fractures and cognitive state: patient outcomes and proxies' perceptions of the rehabilitation period.

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1
Senior Lecturer, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden, and The Swedish Red Cross University College of Nursing, Stockholm, SwedenSenior Lecturer, Department of Health Sciences and Social Work, School of Health Sciences and Social Work, Växjö University, Växjö, SwedenProfessor Emerita, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, SwedenSenior Lecturer, The Swedish Red Cross University College of Nursing, Stockholm, Sweden, and Karolinska Institutet, Department of Clinical Science, Intervention and Technology, Karolinska University Hospital, Stockholm, Sweden.

Abstract

Background.  Numerous studies are available on hip fracture and rehabilitation outcomes, some mention dementia but very few from a family/proxy perspective. Aim.  To investigate whether cognitive state influences the hip fracture patients' rehabilitation outcomes as well as the proxies' perceptions of the 6-month rehabilitation period. Design.  A survey with structured and unstructured questions. Statistics and content analysis. Methods.  The questionnaire was sent to 40 proxies of hip fracture patients with and without cognitive impairment, 32 replied. Statistics and content analysis were used to analyse the data. Results.  In the cognitively impaired group, physical function decreased (P = 0.0241) as well as locomotion (P = 0.0005) compared to pre-fracture. This group mainly participated in rehabilitation sessions in institutions (P = 0.0001) and their main support came from nursing staff. The cognitively impaired group assessed the rehabilitation period as being of a much lower quality than the cognitively intact group (P = 0.0048). In the impaired group, hindrances to rehabilitation were low level of staffing, and lack of access to rehabilitation resources such as physiotherapists. Conclusions and relevance for clinical practice.  Hip fracture patients are a dichotomous group and cognition is decisive for physical and social outcomes as well as type of rehabilitation support.

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