Effects of Dementia on Postoperative Outcomes of Older Adults With Hip Fractures: A Population-Based Study

Objective: To evaluate the association between dementia and postoperative outcomes of older adults with hip fractures. Design: Population-based, retrospective cohort study. Setting: Province of Ontario, Canada. Participants: All individuals with hip fractures who underwent hip fracture surgery in Ontario, Canada between April 1, 2003 and March 31, 2010 were identified. Physician-diagnosed dementia, prior to hip fracture, was identified using a diagnostic algorithm in the administrative databases. Measurements: The preoperative characteristics of older adults with and without dementia were compared separately for individuals admitted to hospital from community or long-term care (LTC). Multivariable regression was used to compare postoperative health service utilization, time with LTC admission, and mortality for individuals with and without dementia. Results: A total of 45,602 older adults had hip fractures and individuals with dementia accounted for 23.9% and 83.5% of all hip fractures from the community and LTC settings, respectively. Compared with those without dementia, individuals with dementia were less likely to be admitted to rehabilitation facilities. Among community-dwelling older adults, dementia was associated with an increased risk of LTC admission [hazard ratio (HR) 2.49, 95% confidence interval (CI): 2.38-2.61, P <.0001]. Dementia was also associated with a higher mortality for older adults from community (HR 1.47, 95% CI: 1.41 -1.52, P <.0001) and LTC (HR 1.10; 95% CI: 1.02-1.18, P=.005) settings. Conclusions: Dementia is common among older adults with hip fractures and associated with poor prognosis following hip fracture surgery. Specialized services targeting the growing number of older adults with dementia may help to prevent hip fractures and optimize postoperative care for this vulnerable population. (C) 2014 -American Medical Directors Association, Inc. All rights reserved.