Clinical guidance on how to care for older patients with dementia after a hip fracture is “sadly lacking” according to the authors of a Cochrane review.
While almost half of all people who suffer hip fractures also have dementia, a Cochrane Review has revealed there is no conclusive evidence on how to care for this particularly vulnerable group.
“We reviewed all the evidence that currently exists, but found it to be sadly lacking”
The review identified an urgent need for better research into what strategies improve post-operative care – both within hospital settings and in the community.
Lead researcher Dr Chris Fox, from the University of East Anglia, noted that hip fractures accounted for 1.8 million bed days in the UK and around £1.9bn in hospital costs.
“More than 40% of people with a hip fracture also have dementia – which equates to around 37,000 cases in the UK per year,” he said. “Unfortunately, outcomes are worse for this group of people, who find it more difficult to recover.
“The real problem is that NHS staff lack the evidence to provide the best care,” he said. “Care for these people is more demanding on staffing levels and has an impact on costs of care.
“We wanted to find out what sort of care options work best for this group of people – to find cases of ‘best practice’ that can be rolled out to ensure that dementia patients have the best possible chance to make a good recovery,” he added.
The researchers set out to assess the effectiveness of different types of care, including rehabilitation strategies designed specifically for people with dementia, compared to usual care.
Data was taken from five clinical trials involving 316 dementia patients who had experienced a hip fracture.
The studies looked at how hospital inpatients were cared for, as well as how patients were cared for after discharge. Some patients were followed up for as long as two years after leaving hospital.
However, the Cochrane researchers found the quality of available evidence in all of the studies to be “very low”.
“We reviewed all the evidence that currently exists, but found it to be sadly lacking. For example, none of these trials told us anything about quality of life,” said Dr Fox.
“What this tells us is that there is still a lot of uncertainty about how to care for a common comorbidity in elderly people,” he said.
He added that clinicians needed to know “much more” about the frequency and duration of physiotherapy, whether familiarised routines and assistive technologies helped, and whether patients were better off in hospital, a care home, or their own home.
“We also need to know how factors such as age and stage of dementia affect the outcome of different management strategies,” he said.