Does depression, apathy or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip fracture patients?

Abstract

Objective: Depression, apathy (amotivation) and cognitive impairment are common comorbidities in hip fracture patients, which may adversely affect functional outcome of rehabilitation. We examined whether postfracture measures of mood, motivation or cognition are associated with rehabilitation outcome (defined as functional improvement) in inpatient rehabilitation facilities (IRFs), as compared to skilled nursing facilities (SNFs).

Methods: This prospective study examined elderly patients who received surgical fixation for hip fracture and then received post-acute rehabilitation at an IRF or an SNF. Subjects were characterized at baseline for depression using the Hamilton Rating Scale for Depression, apathy/amotivation using the Apathy Evaluation Scale and mild-moderate cognitive impairment using the Mini-Mental Status Examination. Functional recovery was measured over 12-week follow-up using the Functional Independence Measure.

Results: Fifty-eight subjects were discharged from acute care to an IRF and 39 to an SNF. Patients with depression, apathy or cognitive impairment who received rehabilitation at an IRF had significantly better functional outcomes than similarly impaired patients at SNFs, and similar outcomes such as nondepressed, motivated and cognitively intact elderly at IRFs.

Conclusion: These findings suggest that depression, amotivation or mild-moderate cognitive impairment after hip fracture do not reduce the benefit of post-acute rehabilitation in an IRF.

Figures

Figure 1

Impairment in depression, apathy and cognition scores in 95 hip fracture patients

Figure 2

Functional recovery over 12 weeks after hip fracture, in an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF), among patients divided by (a) Depressed versus nondepressed (Ham-D ≥10 versus ≤9), (b) High versus low apathy scores (AES ≥38 versus ≤37), and (c) Impaired versus unimpaired cognition (MMSE ≤24 versus ≥25). a. Depressed versus nondepressed b. High versus low apathy scores c. Cognitively impaired versus unimpaired

Figure 2

Functional recovery over 12 weeks after hip fracture, in an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF), among patients divided by (a) Depressed versus nondepressed (Ham-D ≥10 versus ≤9), (b) High versus low apathy scores (AES ≥38 versus ≤37), and (c) Impaired versus unimpaired cognition (MMSE ≤24 versus ≥25). a. Depressed versus nondepressed b. High versus low apathy scores c. Cognitively impaired versus unimpaired

Figure 2

Functional recovery over 12 weeks after hip fracture, in an inpatient rehabilitation facility (IRF) or a skilled nursing facility (SNF), among patients divided by (a) Depressed versus nondepressed (Ham-D ≥10 versus ≤9), (b) High versus low apathy scores (AES ≥38 versus ≤37), and (c) Impaired versus unimpaired cognition (MMSE ≤24 versus ≥25). a. Depressed versus nondepressed b. High versus low apathy scores c. Cognitively impaired versus unimpaired