Three Care Models for Elderly Patients With Hip Fracture

• Depressive symptoms [ Time Frame: 1, 3, 6, 12 months after hospital discharge ] [ Designated as safety issue: No ]
  Depressive symptoms were assessed using the Chinese version of the Geriatric Depression Scale, short form (GDS-s). Patients with a score ≥ 5 were categorized as at risk for clinical depression.
• Nutritional status [ Time Frame: 1, 3, 6, 12 months after hospital discharge ] [ Designated as safety issue: No ]
  Nutritional status was assessed using the Mini Nutritional Assessment (MNA). MNA scores categorize each person as well-nourished (≥24 points), at risk of malnutrition (17-23.5 points), and malnourished (<17 points).

Hip fracture in the elderly is associated with excess mortality of 5 to 20%, and mobility problems that usually results in costly hospital stays and lengthy rehabilitation procedures. The purpose of this study is to compare the costs and effectiveness of three care models- acute/sub-acute, comprehensive, and routine care models for hip fractured elders in Taiwan.

Hip fracture in the elderly is associated with excess mortality of 5 to 20%, and mobility problems that usually results in costly hospital stays and lengthy rehabilitation procedures. With this increase in the aging population, hip fracture represents a major and a fast growing health care problem in Taiwan. Currently, the incidence rate of hip fractures is 10 times of the incidence rate for the general population. Despite the use of advanced treatment, the one-year mortality rate (15.4%) remains significant, and many of the patients never recover completely in terms of activities of daily living functions. Many studies in the United States have proved that elderly patients with hip fracture can benefit from post-operative rehabilitation, early discharge planning programs, or transitional care programs. However, little is known about what intervention should be attempted for these patients and their families in Taiwan.

The purpose of this study is to compare the costs and effectiveness of three care models- acute/sub-acute, comprehensive, and routine care models for hip fractured elders in Taiwan.

• Other: Comprehensive care
  Comprehensive care consisted of subacute care plus health-maintenance interventions to manage depressive symptoms, manage malnutrition, and prevent falls.
  Other Name: Comprehensive care
• Other: Subacute care
  Subacute care included geriatric consultation, continuous rehabilitation, and discharge planning.
  Other Name: Subacute care

• No Intervention: Control group
  Patients receive only usual hospital care
• Subacute care group
  Patients receive hospital usual care and subacute care. Subacute care consisted of geriatric consultation, a rehabilitation program, and early discharge planning.
  Intervention: Other: Subacute care
• Experimental: Comprehensive care group
  Patients receive not only the subacute care (geriatric consultation, rehabilitation program, and discharge planning), but also health-maintenance interventions to prevent falls, consult on nutrition, and manage depression.
  Intervention: Other: Comprehensive care

Inclusion Criteria:

• Age 60 years or older
• Admitted to hospital for an accidental single-side hip fracture
• Receiving hip arthroplasty or internal fixation
• Able to perform full range of motion against gravity and against some or full resistance, and have a pre-fracture Chinese Barthel Index (CBI) score >70
• Living in northern Taiwan

Exclusion Criteria:

• Severely cognitively impaired and completely unable to follow orders (determined by a Chinese Mini-Mental State Examination [MMSE] score <10), or
• Terminally ill