Days Spent at Home Before Hip Fracture can be a predictive factorof post-fracture recovery and mortality for older adults with Alzheimer’s Disease or Related Dementias

Older adults living with Alzheimer’s disease or related dementias (ADRD) have higher incidence and worse outcomes after a hip fracture. Days Spent at Home before the hip fracture episode could be taken into consideration at surgical decision making and discharge planning.

This study undertaken in USA explored the association between days at home (DAH) before a hip fracture and post-fracture outcomes, including 1-year mortality, in 16576 community-dwelling older adults living with ADRD.

Days at Home were calculated based on the number of days that each patient was alive and not in hospitals, skilled nursing facilities, days in hospital observation or emergency department during the study period (6 months prior to and 12 months post hip fracture).

A fundamental result of this study was that pre-fracture DAH offered valuable prognostic information about post-fracture recovery of this vulnerable population, as patients in more unfavorable pre-fracture condition with a lower number of DAH had:

• 65% higher risk for mortality at 1 year than those who spent the majority of their pre-fracture days at home and
• more than double probability of spending more days of the post-fracture period hospitalized or in institutional care settings.

Furthermore, higher number of DAH was significantly associated with full post-fracture recovery. This finding is of major importance, according to the authors of this study, due to the fact that it helps ‘raise recovery expectations’ and ‘undercut common misconceptions contributing to underutilization of aggressive rehabilitation care’ in these patients.

DAH can be used as an objective measure to report preoperative health of older adults with ADRD and contribute at the optimal decision making either for surgery, discharge or post-discharge care.

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