Dementia as a cofactor for geriatric rehabilitation-outcome in patients with
osteosynthesis of the proximal femur
A retrospective, matched-pair analysis of 250 patients
, Tom Krause, Christina Niehuus, Wolfgang von Renteln-Kruse
Medizinisch-Geriatrische Klinik, Albertinen-Haus, Wissenschaftliche Einrichtung an der Universita
t Hamburg, Sellhopsweg 18-22, 22459 Hamburg, Germany
The percentage of cognitive impairment (dementia and/or
delirium)of elderly hospitalizedpatientshasbeenreportedbetween
10% and 56% (Levkoff et al., 1992; Lipowski, 1994; Pompei et al.,
1994). Proximal femur fractures (PFF) are among the most common
fractures among the elderly. In Germany, approximately 118,000
were documented per year (Drastig and Drastig, 2007). Because of
the demographic changes, dementing illnesses and PFF will raise in
number. Also, dementia is associated with a higher risk of PFF
(Morris et al., 1987). As a consequence, an increasing number of
patients with both conditions will be treatedin surgical and geriatric
wards. There is an ongoing discussion, if and to what extent
cognitive abilities do inﬂuence functional outcome (Sta
So far, there have been some studies addressing this question with
conclusions drawn that span from no to strong inﬂuence of cognition
on outcome (e.g., Goldstein et al., 1997; Heruti et al., 1999;
Beloosesky et al., 2001; Gruber-Baldini et al., 2003).
We studied this question by using matched-pair analysis of our
own data. We analyzed the data of 250 patients with elective hip
replacement or osteosynthesis due to PFF. One half of the patients
had additional dementia. We wanted to know to what extent
dementia inﬂuenced functional outcome, the rate of in-hospital
falls, the rate of hip displacement and patient placement after
discharge. We additionally evaluated whether the amount of
individual physiotherapy was different between both groups. Both
groups were matched in a pair by pair fashion equalizing age,
gender, surgical procedure and mobility status on admission.
2. Patients and methods
2.1. Patient selection
In 2003, all consecutive patients with either a fracture of the
proximal femur or an elective hip replacement therapy were
included in the study. The patients were divided into two groups.
The ﬁrst group included all patients who had an additional
diagnosis of a dementing illness according to ICD-10 (The ICD-10
Classiﬁcation of Mental and Behavioural Disorders. World Health
Organization, Geneva, 1992). The diagnosis had to be based on a CT
or MRI scan of the brain within the last year and neuropsycho-
logical testing within the preceding year. The actual Mini Mental
State Examination (MMSE) score had to be 23. Patients who
endured a stroke within the last 8 weeks were excluded. In the
second group, we collected data of all patients without dementia.
Their actual MMSE score had to be !24.
Archives of Gerontology and Geriatrics 49 (2009) e36–e39
Received 13 May 2008
Received in revised form 8 August 2008
Accepted 14 August 2008
Available online 1 October 2008
A raising number of patients with osteosynthesis of the proximal femur and additional dementia will be
seen in hospitals in the future due to demographic changes. There is an ongoing discussion, if and to what
extent cognitive abilities do inﬂuence functional outcome in geriatric rehabilitation. We therefore
compared 250 patients with osteosynthesis of the proximal femur of whom one half had additional
dementia, by a matched-pair analysis for the improvement of mobility assessed by the mobility items of
the Barthel Index and the Tinetti mobility index. Dementia was an important cofactor for the success of
geriatric rehabilitation. Patients with additional dementia reached lower mobility scores at discharge.
Also, patients with dementia had signiﬁcantly more in-hospital falls. Furthermore, the study revealed
that demented patients received less individual and group therapy per hospital day. The study underlines
the need for specialized wards treating demented patients with additional illnesses.
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E-mail address: email@example.com (A. Ro
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