Abstract
BackgroundHip fractures among older adults remain a public concern. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. The consequences may be more challenging if an older adult also has a compromised cognitive reserve. Although rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown.ObjectiveThe objective of this study is to develop a systematic review protocol focused on identifying the evidence and evaluating the effectiveness of post discharge rehabilitation programs for older adults with a cognitive impairment following a hip fracture.MethodsThe search strategy will include a combination of text words and subject headings relating to the concepts of cognitive impairment, dementia, delirium, cognitive reserve, and hip fractures. Searching various databases will identify peer-reviewed journal articles. There will be two independent reviewers who will screen the titles and abstracts to determine which articles comprise a rehabilitation intervention within a community setting prior to being included for a full article review. A data extraction form and an evidence and quality checklist will be used during the full article data analysis and synthesis. It is expected that there will be a paucity of studies that focus on post discharge rehabilitation interventions for older adults with cognitive impairment following a hip fracture, and few studies that use the same or similar outcome measures. However, if possible, a meta-analysis will be conducted on studies that used similar outcome methods.ResultsThis review will synthesize knowledge focusing on activities to maintain and restore function in older adult patients with cognitive impairment once they have completed their active rehabilitation program and return home. A synthesis of the findings will be conducted to determine which components of the interventions identified were the most advantageous to the patient population. The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture.ConclusionsThe aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture. With the support and contributions by our associated knowledge users, this systematic review will be used to help inform procedures and policies to facilitate the necessary care and resources required by our patient population.
Highlights
Older Adults and Hip FracturesWith approximately 35,000 a year in Canada and projections that indicate that the incidence will increase nearly four-fold by 2041, hip fractures remain a public health concern [1,2]
The results will be used to develop a multi-faceted post discharge rehabilitation intervention aimed at enabling older adults to return and remain living at home after a hip fracture
JMIR Res Protoc 2014 | vol 3 | iss. 3 | e47 | p.1 van Wyk et al Conclusions: The aim of this systematic review is to generate results that can be used to create interventions that focus on the care necessary to enable older adults to remain living at home post discharge from acute or inpatient rehabilitation care for a hip fracture
Summary
Older Adults and Hip FracturesWith approximately 35,000 a year in Canada and projections that indicate that the incidence will increase nearly four-fold by 2041, hip fractures remain a public health concern [1,2]. There is evidence to suggest that community-based rehabilitation programs can be beneficial [6,7], there has yet to be a synthesis of studies that focused on community-based rehabilitation interventions post discharge from the hospital for older adults with a CI following a hip fracture. In response to the need for better services for older adults with CI, previous research involved the development of a Patient-Care Rehabilitation Model for patients with a hip fracture including persons with CI (PCRM-CI) [8]. The review protocol presented in this paper will concentrate on community-based rehabilitation, post hospital discharge interventions, focused on older adults with CI following a hip fracture. Consequences of a hip fracture include the subsequent decline in function and mobility for the older adult, and an increased burden placed upon their caregivers and the health care system. Rehabilitation programs have proven effective, the best practices and resources required to maintain the gains in function and mobility, to negate diminution of effect, and to enable this patient population to continue living at home are currently unknown
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