Physiotherapy interventions for people with dementia and a hip fracture-a scoping review of the literature.

BACKGROUND: People with dementia are 2.7 times more likely to suffer a hip fracture than those without and their management is estimated to cost £0.92 billion per year. Yet there has been little focus on the effectiveness of interventions for this population. OBJECTIVE: The aim of this scoping review was to summarise the current available evidence for physiotherapy interventions for people with dementia who fracture their hip as well as to identify gaps in the literature that may require further research. DATA SOURCES: A systematic search of the following databases was undertaken-TRIP, CINAHL, Amed, Embase, PEDro, PsycINFO, Cochrane Library, Open Grey, Ethos, ISRCTN, Proquest, PROSPERO and UK Clinical Trials Gateway. STUDY SELECTION: Articles were included if they described an intervention which is considered within the scope of a physiotherapist and targeted those with both a hip fracture and dementia. SYNTHESIS METHODS: A narrative summary was then undertaken to describe the current state of the literature. RESULTS: Twenty six studies were included, of which thirteen were observational, six RCTs, two qualitative, two surveys and three systematic reviews. Only nine studies focused explicitly on physiotherapy interventions. CONCLUSION: The findings of this scoping review suggest there is limited evidence to guide physiotherapists in the management of people with dementia who fracture their hip. No evidence was found about perceptions or experiences of patients in this group or of the physiotherapists involved in their care. Further research is needed to develop and evaluate physiotherapy interventions for people with dementia who fracture their hip

Risk factors for falls in older adults in a South African Urban Community

Background: Studies on falls in older adults have mainly been conducted in high income countries. Scant, if any, information exists on risk factors for falls in the older population of sub-Saharan African countries. Methods: A cross-sectional survey and a 12-month follow-up study were conducted to determine risk factors for falls in a representative multi-ethnic sample of 837 randomly selected ambulant community-dwelling subjects aged ≥65 years in three suburbs of Cape Town, South Africa. Logistic regression models were fitted to determine the association between (1) falls and (2) recurrent falls occurring during follow-up and their potential socio-demographic, self-reported medical conditions and physical assessment predictors. Results: Prevalence rates of 26.4 % for falls and 11 % for recurrent falls at baseline and 21.9 % for falls and 6.3 % for recurrent falls during follow-up. In both prospective analyses of falls and recurrent falls, history of previous falls, dizziness/vertigo, ethnicity (white or mixed ancestry vs black African) were significant predictors. However, poor cognitive score was a significant predictor in the falls analysis, and marital status (unmarried vs married) and increased time to perform the timed Up and Go test in the recurrent fall analysis but not in both. Other than the timed Up and Go test in recurrent falls analysis, physical assessment test outcomes were not significant predictors of falls. Conclusion: Our study provides simple criteria based on demographic characteristics, medical and physical assessments to identify older persons at increased risk of falls. History taking remains an important part of medical practice in the determination of a risk of falls in older patients. Physical assessment using tools validated in developed country populations may not produce results needed to predict a risk of falls in a different setting

Unequal opportunities for patients with and without cognitive impairment : relatives' and significant others' views on care and rehabilitation after hip fracture

The overall aim of the studies that form the basis of this doctoral thesis was to explore how cognitive impairment affects the care and rehabilitation of hip fracture patients, as revealed by their relatives and significant others. A further aim was to investigate to what extent dementia, delirium and other comorbid conditions in hip fracture patients was put on record in Stockholm County Council’s In-patient Care Register (ICR) database. Study I focused on frequencies of dementia and delirium diagnoses in a hip fracture population (I). Study II focused on the relatives and significant others views on the conditions of rehabilitation for older patients with dementia. Study III focused on how relatives to cognitively impaired and cognitively intact hip fracture patients experienced the first six months post fracture, in order to determine whether the patients’ cognitive impairment affected the relatives’ experiences. Study IV focused on cognitively impaired and cognitively intact hip fracture patients’ outcomes and their proxies’ perceptions of a sixmonth rehabilitation period. The results are based on data from 14 993 hip fracture patients (from 1994 to 1999) registered in the ICR, aged 65 years or older (I). Moreover, interview data from the 20 relatives (aged 37 to 88 years) to the patients with cognitive impairment (II), diaries from 11 relatives to patients with and without cognitive impairment (III), and questionnaires from 32 relatives to patients with and without cognitive impairment (IV). The Mini Mental State Examination (MMSE) and Katz´ Activities of Daily Living Index (ADL) were used to assess the patients. The patients were recruited consecutively, together with their relatives (spouses, children, and other relatives) and other significant persons (friends and staff). The data were analysed with descriptive statistics and correlations (I), content analysis (II), latent content analysis (III) and comparative statistics and manifest content analysis (IV). Based on the result of the four studies in this thesis, it can be concluded that patients with cognitive impairment, i.e. dementia and confusion, are not given the care and attention they need after a hip fracture. This is based on the relatives’ views and assertions, which point out that rehabilitation outcomes for cognitively impaired patients are less successful and that their rehabilitation care is less carefully prepared and/or supported by physiotherapists, when compared to cognitively intact patients. This leads to greater dissatisfaction among relatives to hip fracture patients with cognitive impairment. The results indicate that health personnel lack knowledge and strategies that can control and prevent the cognitively impaired patients’ behaviour and support them during rehabilitation. Moreover, although the in-patient care register seems to be suitable for planning hip fracture care, it may not be appropriate for patients with comorbid diagnoses, since the register was found to be unreliable in relation to the secondary diagnoses of dementia and delirium. This indicates unequal opportunities for hip fracture patients with and without cognitive impairment. The way forward implicates an improvement in education, guidelines, and support, so that cognitively impaired patients’ are given the opportunity to complete their rehabilitation programmes. Furthermore, a more friendly approach is required when dealing with cognitively impaired patients in various care settings

Associations between falls and general health, nutrition, dental health and medication use in Swedish home-dwelling people aged 75 years and over

The vast majority of elderly people in Sweden live in private homes in their communities for as long as possible. Poor health and a high risk of falls are very common among this group. This cross-sectional study investigates the association between falls and general health, appetite, dental health, and the use of multiple medications among home-dwelling men and women aged ≥75 years. Data were collected between October 2008 and March 2009 using a postal questionnaire. A total of 1243 people participated in the questionnaire survey (74% response rate), of which 1193 were included in the analysis. The majority of participants were women (n = 738, 62%). Falls in the previous 12-month period were reported by 434 (36%) participants. Most fallers (n = 276, 64%) were women. The majority of the fallers lived in a flat (n = 250, 58%). Poor health (aOR: 1.61; CI: 1.34-1.95), poor dental health (aOR: 1.22; CI: 1.07-1.39) and the use of four or more types of medication daily (aOR: 1.13; CI: 1.03-1.25) were significantly associated with falls in all participants. Poor dental health was found irrespectively of living in a flat (aOR: 1.23; CI: 1.04-1.46) or living in a house (aOR: 1.28; CI: 1.02-1.61), and both were significantly associated with falls. The use of more than four different types of medication daily (aOR: 1.25; CI: 1.11-1.41) was associated with falls for those living in a flat. The results highlight that falls are associated with poor general health, poor dental health and the use of four or more types of medication daily. Health professionals should provide health promotion education and investigate dental health and risk factors for oral disease. Likewise, medical and clinical practices of physicians and community care nurses should include assessing the risk of falling, and treatment that predisposes falls