Combining diagnostic memory clinic with rehabilitation follow-up after hip fracture

• Published in: European geriatric medicine Vol. 11; no. 4; pp. 603 - 611
• Main Authors: Jaatinen, Roope, Luukkaala, Tiina, Viitanen, Matti, Nuotio, Maria S.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-08-2020
• Subjects: Geriatrics/Gerontology; Internal Medicine; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Research Paper; Hip fracture; Physical functioning; Cognitive disorder; Older people
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-020-00334-x

Key summary points
Aim
To specify the various diagnoses of cognitive disorders detected in post-hip fracture follow-up.
Findings
Previously undiagnosed cognitive disorders are common in older hip fracture patients and are associated with impaired physical functioning and poor nutritional status.
Message
The assessment of cognitive impairment is important alongside the comprehensive evaluation of hip fracture rehabilitation.
Purpose
Cognitive impairment and dementia are common in older hip fracture patients. We describe new diagnoses of cognitive disorders (NDCDs) and associated factors in a two-year post-hip fracture follow-up including the use of the diagnostic facilities of a memory clinic.
Methods
Data were collected on admission and at outpatient assessment 4–6 months post-hip fracture. Diagnoses of cognitive disorders followed the evidence-based Finnish national care guideline including internationally accepted criteria. NDCDs up to 2 years post-hip fracture were extracted manually from the patient files. Logistic regression models were computed to examine the associations between the pre-fracture factors and the domains of the outpatient geriatric assessment and NDCDs.
Results
Of the 1165 hip fracture patients aged ≥ 65 years, 831 had no previous diagnosis of cognitive disorder. Of these, NDCD was documented in 23.3%. Alzheimer’s disease (AD) with or without vascular cognitive impairment (VCI) was the most common diagnosis. Cognitive disorder was usually at a moderate stage. Age, higher ASA score and poor nutritional status on admission were associated with new cognitive disorders. At the outpatient follow-up, poorer activities of daily living and mobility disability were associated with NDCD. Patients with a NDCD were more likely to suffer greater mobility impairment, poorer nutritional status and to have more supported living arrangements at follow-up than in the pre-fracture situation.
Conclusion
NDCDs are common after hip fracture and associated with impaired rehabilitation outcomes and poor nutritional status. A post-hip fracture assessment co-organized in the form of a memory clinic seems to be feasible to detect previously undiagnosed cognitive disorders. Earlier diagnosis of cognitive disorders is warranted.