Length of Hospital Stay for Hip Fracture and 30-Day Mortality in People With Alzheimer's Disease: A Cohort Study in Finland

Background: Persons with Alzheimer's disease (AD) are at higher risk of hip fractures (HFs) than general older population and have worse prognosis after HF. Hospital stays after HF have shortened along time. We investigated the association between length of hospital stay after HF and mortality after discharge among persons with AD. Method: The MEDALZ cohort includes all Finnish community dwellers who received clinically verified AD diagnosis in 2005-2011 (N = 70 718). Patients who experienced first HF after AD diagnosis in 2005.2015 (n = 6999) were selected. Length of hospital stay for HF was measured as a sum of the consecutive days spent in hospital after HF until discharge. Outcome was defined as death within 30 days after hospital discharge. Results: Mean of overall length of hospital stay after a HF decreased from 52.6 (SD 62.9) days in 2005 to 19.6 (SD 23.1) days in 2015. Shortest treatment decile (1.4 days) had the highest risk of death within 30 days after discharge (adjusted hazard ratio [aHR] 2.76; 95% confidence interval [CI] 1.66-4.60) in addition to second (5.6 days; aHR 2.52; 95% CI 1.50-4.23) and third (7.10 days; aHR 2.22; 95% CI 1.34-3.69) deciles when compared to the sixth decile of length of stays (21.26 days). Conclusions: Among persons with AD, shorter length of hospital stay after HF was associated with an increased risk of death after discharge. After acute HF treatment, inpatient rehabilitation or proper care and services in home need to be organized to older persons with AD.