Acute Care and Rehabilitation After Low-Trauma Hip Fractures in Older Adults—Pathways and Functional Outcomes: A Retrospective Cohort Study
TL;DR
Individuals with FN-F, Tr-F, and Ac/Pp-F fractures follow healthcare pathways in different frequencies and have different pathway durations, which may support the identification of future opportunities to improve continuity of healthcare, including orthogeriatric management and specialized rehabilitation.
Abstract
Background/Objectives: This study describes, first, healthcare pathways, including inpatient rehabilitation, and, second, functional outcomes for these low-trauma hip fracture (LTHF) types (femoral neck (FN-F), trochanteric (Tr-F), and acetabulum/periprosthetic (Ac/Pp-F) fractures). Methods: This single-center, retrospective cohort study, 2020–2023, included patients aged ≥65 years, with FN-F, Tr-F, or Ac/Pp-F, admitted to inpatient rehabilitation. Pathways comprised acute care, inpatient rehabilitation, and temporary care homes, bounded by pre-fracture situation and discharge destination. Pairwise Standardized Mean Differences (SMDs) were calculated to determine between-group differences. Results: Of 294 individuals (mean age 81.0 ± 7.4 years; 191 (65%) women; 152 Tr-F, 118 FN-F, and 24 Ac/Pp-F), four main pathways were identified: (1) acute care to inpatient rehabilitation in 208 (70.7%) individuals, (2) temporary care home stays before rehabilitation in 25 (8.5%), (3) temporary care home stays after rehabilitation in 17 (5.8%), and (4) re-hospitalization in 44 (15.0%). Median pathway length was 33.0 days (IQR 26.0–40.0) for FN-F, 35.0 (IQR 29.0–46.0) for Tr-F, and 60.5 (IQR 37.0–86.5) for Ac/Pp-F. Between-group differences in pathway type were moderate to large (SMDs: FN-F vs. Tr-F = 0.47; FN-F vs. Ac/Pp-F = 1.25; Tr-F vs. Ac/Pp-F = 0.84), and for length, small to large (SMDs: FN-F vs. Tr-F = 0.36; FN-F vs. Ac/Pp-F = 1.2; Tr-F vs. Ac/Pp-F = 0.69). Overall, 246 (83.7%) returned to a permanent private living setting. A total of 88 (29.9%) required new or increased home support or care. At discharge from rehabilitation, among participants who completed the program, the Functional Independence Measure and the Timed Up and Go test showed small-to-moderate between-group differences. Conclusions: Individuals with FN-F, Tr-F, and Ac/Pp-F fractures follow healthcare pathways in different frequencies and have different pathway durations. The findings may support the identification of future opportunities to improve continuity of healthcare, including orthogeriatric management and specialized rehabilitation.