Survival benefits of post-acute care for older patients with hip fractures in Taiwan: A 5-year prospective cohort study.

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To evaluate the survival benefits of different models of post-acute care (PAC) services for older patients with hip fractures in Taiwan This was a prospective cohort study that recruited elderly patients with hip fractures receiving surgical treatment from 2007 to 2009 for study. All patients were provided home-based PAC, institution-based PAC or conventional home care (CHC) based on their capacity of family care resources. Functional status and survival status was followed for 4 years. Overall, 453 hip fracture patients (mean age 81.9 ± 6.8 years, 58.8% men) were recruited for the present study. Among them, 29.4% (133/453) patients received home-based PAC, 25.6% (116/453) patients received institution-based PAC and 45.0% (204/453) received CHC. During follow up, 28.9% (131/453) died within the mean of 940.3 ± 453.40 days. Adjusted for age, sex, living status, visual acuity, mood status, previous fall history, and prefracture activities of daily living (ADL) and instrumental activities of daily living (IADL), ADL fully recovered patients were significantly more likely to survive in the 4-year follow up (HR 2.791, P = 0.01, 95% CI 1.261-6.149). Patients receiving either home- or institution-based PAC had better survival than the CHC group after adjustment for age, sex, living status, visual acuity, mood status, previous fall history, prefracture ADL and IADL (HR 0.486, P = 0.008, 95% CI 0.284-0.832 for home-based PAC; HR 0.546, P = 0.036, 95% CI 0.311-0.960 for institution-based PAC). PAC services were of great survival benefit for elderly hip fracture patients, and the home-based model was more likely to achieve complete functional recovery, which was important for long-term survival.