Rehabilitation outcome of elderly patients with hip fracture and cognitive impairment

Purpose: To assess the association between cognitive status and functional gain during a rehabilitation programme for elderly patients with hip fracture. Method: Prospective study in a hospital geriatric rehabilitation unit. Sixty-one consecutive patients were studied: 28 with cognitive impairment (age 87.6 +/- 7.2 years, Mini Mental State Examination (MMSE) score 11.25 +/- 5.9), 23 with possible cognitive impairment (age 83.9 +/- 6.8 years, MMSE 22.65 +/- 1.6) and 10 without cognitive impairment (age 77.6 +/- 7.4 years, MMSE 29.5 +/- 0.9). Cognitive status was assessed with the MMSE and admission and discharge functional status with the Functional Independence Measure (FIM). Functional gain was calculated by absolute FIM gain ( admission FIM minus discharge FIM), relative ( to maximum potential) FIM gain with the Montebello Rehabilitation Factor Score (MRFS) and analysis of covariance of the FIM (ANCOVA). Results: Patients without cognitive impairment had significantly higher admission FIM and discharge FIM. Cognitive status was not significantly associated with absolute functional gain. The adjusted ( age, gender, sensory impairment, nutritional status, comorbidity and treatment) MRFS score of cognitively impaired patients was significantly lower (p<0.03). However, the functional gain related to baseline functional status ( ANCOVA) was not significantly different between the groups. Conclusions: In spite of cognitive impairment, elderly patients with hip fracture can benefit from participation in rehabilitation programmes.