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Geriatric Rehabilitation and Discharge Location After Hip Fracture in Relation to the Risks of Death and Readmission

Published:August 18, 2015DOI:https://doi.org/10.1016/j.jamda.2015.07.004

      Abstract

      Objectives

      To investigate the effects of geriatric rehabilitation on short-term risk of death and readmission after a hip fracture were investigated in a nationwide cohort. In addition, the association of discharge location (nursing home or patient's home) with the short-term risk of death was assessed.

      Design, Setting, and Participants

      The cohort consisted of 89,301 individuals at least 50 years of age, with a first hip fracture registered in the Swedish quality register RIKSHÖFT, the years 2004–2012.

      Measures

      Short-term risk of death and readmission to hospital after discharge was compared at 8 hospitals, where most patients received inpatient care in geriatric wards, and those treated at 71 regular hospitals.

      Results

      The risks of death within 30 days of admission were 7.1% in patients admitted to geriatric ward hospitals and 7.4% in those treated at regular hospitals (multivariable-adjusted hazard ratio [HR] 0.91, 95% CI 0.85–0.97), whereas the odds of readmission within 30 days of discharge were 8.7% and 9.8%, respectively (multivariable-adjusted odds ratio 0.86, 95% CI 0.81–0.91). The risk of death was influenced by discharge location and inpatient length of stay (LOS). Thus, for patients discharged to short-term nursing homes with a LOS of at most 10 days, each additional day of LOS reduction increased the risk of death within 30 days of discharge by 13% (HR 1.13, 95% CI 1.08–1.18). This association was reduced in patients discharged to permanent nursing homes (HR 1.04, 95% CI 1.02–1.07), and not significant in those discharged to their own home (OR 1.00, 95% CI 0.91–1.10).

      Conclusion

      The risks of death and readmission were lower in patients with hip fracture who received care in hospitals with geriatric wards. The risk of death after discharge increased with shorter LOS, especially in patients discharged to short-term nursing homes.

      Keywords

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      References

        • United Nations
        World Population Prospects. The 2012 Revision. ESA/P/WP.227.
        Department of Economic and Social Affairs, Population Division, New York, NY2013
        • Bloom D.E.
        • Cafiero E.T.
        • Jané-Llopis E.
        • et al.
        The Global Economic Burden of Noncommunicable Diseases.
        World Economic Forum, Geneva2011
        • Kondilis E.
        • Giannakopoulos S.
        • Gavana M.
        • et al.
        Economic crisis, restrictive policies, and the population's health and health care: The Greek case.
        Am J Public Health. 2013; 103: 973-979
      1. Organisation for Economic Co-operation and Development (OECD). Health at a Glance: Europe 2012, http://dx.doi.org/10.1787/9789264183896-en. Accessed February 1, 2015.

        • Clarke A.
        • Rosen R.
        Length of stay. How short should hospital care be?.
        Eur J Public Health. 2001; 11: 166-170
        • Qureshi A.
        • Gwyn Seymour D.
        Growing knowledge about hip fracture in older people.
        Age Ageing. 2003; 32: 8-9
        • Nordstrom P.
        • Gustafson Y.
        • Michaelsson K.
        • Nordstrom A.
        Length of hospital stay after hip fracture and short term risk of death after discharge: A total cohort study in Sweden.
        BMJ. 2015; 350: h696
        • Kennie D.C.
        • Reid J.
        • Richardson I.R.
        • et al.
        Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: A randomised clinical trial.
        BMJ. 1988; 297: 1083-1086
        • Vidan M.
        • Serra J.A.
        • Moreno C.
        • et al.
        Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: A randomized, controlled trial.
        J Am Geriatr Soc. 2005; 53: 1476-1482
        • Stenvall M.
        • Olofsson B.
        • Lundstrom M.
        • et al.
        A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture.
        Osteoporos Int. 2007; 18: 167-175
        • Gonzalez-Montalvo J.I.
        • Alarcon T.
        • Mauleon J.L.
        • et al.
        The orthogeriatric unit for acute patients: A new model of care that improves efficiency in the management of patients with hip fracture.
        Hip Int. 2010; 20: 229-235
        • Prestmo A.
        • Hagen G.
        • Sletvold O.
        • et al.
        Comprehensive geriatric care for patients with hip fractures: A prospective, randomised, controlled trial.
        Lancet. 2015; 385: 1623-1633
        • Thorngren K.G.
        Fractures in the elderly.
        Acta Orthop. 1995; 266: 208-210
        • Thorngren K.G.
        • Norrman P.O.
        • Hommel A.
        • et al.
        Influence of age, sex, fracture type and pre-fracture living on rehabilitation pattern after hip fracture in the elderly.
        Disabil Rehabil. 2005; 27: 1091-1097
        • Ludvigsson J.F.
        • Andersson E.
        • Ekbom A.
        • et al.
        External review and validation of the Swedish national inpatient register.
        BMC Public Health. 2011; 11: 450
        • Koster M.
        • Asplund K.
        • Johansson A.
        • Stegmayr B.
        Refinement of Swedish administrative registers to monitor stroke events on the national level.
        Neuroepidemiology. 2013; 40: 240-246
        • Hammar N.
        • Alfredsson L.
        • Rosen M.
        • et al.
        A national record linkage to study acute myocardial infarction incidence and case fatality in Sweden.
        Int J Epidemiol. 2001; 30: S30-S34
        • Michaelsson K.
        • Baron J.A.
        • Farahmand B.Y.
        • et al.
        Hormone replacement therapy and risk of hip fracture: Population based case-control study. The Swedish Hip Fracture Study Group.
        BMJ. 1998; 316: 1858-1863
        • Harrell F.
        Regression Modeling Strategies: With Applications to Linear Models, Logistic Regression, and Survival Analysis.
        Springer-Verlag, New York, NY2001
        • Ellis G.
        • Whitehead M.A.
        • Robinson D.
        • et al.
        Comprehensive geriatric assessment for older adults admitted to hospital: Meta-Analysis of randomised controlled trials.
        BMJ. 2011; 343: d6553
        • Huusko T.M.
        • Karppi P.
        • Avikainen V.
        • et al.
        Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: Subgroup analysis of patients with dementia.
        BMJ. 2000; 321: 1107-1111
        • Naglie G.
        • Tansey C.
        • Kirkland J.L.
        • et al.
        Interdisciplinary inpatient care for elderly people with hip fracture: A randomized controlled trial.
        CMAJ. 2002; 167: 25-32
        • Ziden L.
        • Kreuter M.
        • Frandin K.
        Long-term effects of home rehabilitation after hip fracture - 1-year follow-up of functioning, balance confidence, and health-related quality of life in elderly people.
        Disabil Rehabil. 2010; 32: 18-32
        • Aiken L.H.
        • Clarke S.P.
        • Sloane D.M.
        • et al.
        Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.
        JAMA. 2002; 288: 1987-1993
        • Aiken L.H.
        • Sloane D.M.
        • Bruyneel L.
        • et al.
        Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study.
        Lancet. 2014; 383: 1824-1830
        • Rafferty A.M.
        • Clarke S.P.
        • Coles J.
        • et al.
        Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records.
        Int J Nurs Stud. 2007; 44: 175-182