A geriatric multidisciplinary and tailor-made hospital-at-home method in nursing home residents with hip fracture

Nursing home residents represent a large proportion of patients hospitalized with hip fracture. Generally, residents do not achieve the same physical ability level as before their fracture and have an increased risk of death within few days after discharge. This study aims to compare 2 new approaches to geriatric intervention in residents with hip fracture.

In nursing home residents aged 65 or older with hip fracture, 85 received a newly developed standardized rehabilitation intervention undertaken by the geriatric orthopedic team (GO team) from December 1, 2006 to November 30, 2007. This standardized method was compared with a further developed tailor-made intervention method performed by the GO team in 153 residents from February 1, 2008 to January 31, 2010. Both the interventions began at hospital admission and until 30 days after surgery. Outcomes were length of hospital stay (LOS), difference in physical ability, 90-day acute readmission, 30-day mortality, and 90-day mortality.

The tailor-made intervention method reduced the readmission rate (14% vs 26%) compared with the standardized intervention method (odds ratio [OR] = 0.47 [95% confidence interval [CI]: 0.23, 0.94]). Tailor-made intervention reduced 30-day mortality (8% vs 19%) compared with standardized intervention (OR = 0.42 [95% CI: 0.18, 0.97]). Improving 90-day survival could not be demonstrated (81% vs 73%; OR = 0.72 [95% CI: 0.37, 1.40]). Median LOS was 2 days in both the groups. A total of 7 follow-up visits were performed with tailor-made intervention versus 3 visits with standardized intervention. In both the groups, the physical ability decreased significantly within the first 30 postoperative days, with no difference between groups (β = 1.01 [95% CI: 0.82, 1.24]).

A multidisciplinary and tailor-made geriatric intervention in nursing home residents has a positive effect on readmission rate and short-term mortality. Still, it is not obvious which part of the tailor-made intervention is most crucial.