Abstract
Objective
Older adults with dementia are at higher risk for sustaining hip fracture and their
long-term health outcomes after surgery are usually worse than those without dementia.
Widespread adoption of electronic health records (EHRs) may allow hospitals to better
monitor long-term health outcomes in patients with dementia after hospitalization.
This study aimed to (1) estimate how dementia influences discharge location, mortality,
and readmission 180 days and 1 year after hip fracture surgery in older adults, and
(2) demonstrate the feasibility of using selection-bias reduced EHR data for research
and long-term health outcomes monitoring.
Design
Retrospective observational cohort study using EHRs.
Setting and Participants
A cohort of 1171 patients over age 65 years who had an initial hip fracture surgery
between October 2015 and December 2018 was extracted from EHRs of one health system;
376 of these patients had dementia.
Methods
Logistic regression was applied to estimate influences of dementia on discharge disposition
and Cox proportional hazards model for mortality. The Fine and Gray regression model
was used to analyze readmission, accounting for the competing risk of death. To reduce
selection bias in EHRs, inverse probability of treatment weighting using propensity
scores was implemented before modeling.
Results
Dementia had significant impacts on all outcomes: being discharged to facilities [odds
ratio (OR) = 2.11, 95% confidence interval (CI) 1.19–3.74], 180-day mortality [hazard
ratio (HR) = 1.69, 95% CI 1.20–2.38], 1-year mortality (HR = 1.78, 95% CI 1.33–2.38),
180-day readmission (HR = 1.62, 95% CI 1.39–1.89), and 1 year readmission (HR = 1.39,
95% CI 1.21–1.58).
Conclusions and Implications
Dementia was a significant risk factor for worse long-term outcomes. The inverse probability
of treatment weighting approach can be used to reduce selection bias in EHR data for
research and monitoring long-term health outcomes in the target population. Such monitoring
could foster collaborations with post-acute and long-term health care services to
improve recovery outcomes in patients with dementia after hip fracture surgery.
Keywords
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Article info
Publication history
Published online: December 13, 2022
Accepted:
November 5,
2022
Received in revised form:
October 3,
2022
Received:
July 13,
2022
Footnotes
This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
The authors declare no conflicts of interest.
Identification
Copyright
© 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
