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Rehabilitative Outcomes after Hip Fracture in a Special Care Unit for Persons with Dementia and Behavioral and Psychotic Symptoms

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Health 2015年第9期7卷 1175-1182页

作者： Mauro Colombo Silvia Vitali chiara cutaia Eleonora Marelli Antonio Guaita Geriatric Rehabilitation Unit/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Abbiategrasso Italy Golgi Cenci Foundation Abbiategrasso Italy Special Care Unit for Persons with Dementia/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Abbiategrasso Italy

Aim: Hip fracture implies severe problems to older people;special concerns regard persons with dementia, due either to cognitive impairment, or to behavioral and psychic symptoms. This study illustrates rehabilitative outcomes of these patients discharged by a special care unit ruled by “GentleCare” principles. Method: 54 patients [89% females, aged 82.3 years (range 66 - 94)] followed a post-surgery rehabilitative program carried out by a physiotherapist and an occupational therapist, supported by a psychologist. The multidimensional assessment consisted of cognition evaluation (Mini Mental State Examination, Clinical Dementia Rating, Global Deterioration Scale), functional evaluation (Barthel Index, Tinetti Gait and Balance, Bedford Alzheimer Nursing Severity scale), behavioral evaluation (UCLA Neuropsychiatric Inventory) and comorbidity evaluation (Cumulative Illness Rating Scale). Results: All parameters improved, including the 5 most frequent behavioral and psychic symptoms that usually preclude admission in ordinary rehabilitation units. 24% of improvement in Barthel Index total score was explained by agitation and apathy at discharge, in a multiple linear regression model: better functional levels corresponded to smoother behavioral problems. Most patients improved;70.5% of them were discharged to home. Conclusion: A prosthetic approach enables valuable results in the rehabilitation of severely demented patients with hip fracture also in presence of behavioral symptoms.

关键词： Hip Fracture Rehabilitation Special Care Unit for Dementia Gentle Care Behavioral and Psychotic Symptoms of Dementia

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