RPD113 - Days at Home After Hip Fracture Among Older Adults with and without Dementia

Key Message : Older adults with dementia died two months earlier and, if they survived, spent two months less at home in the year after hip fracture compared to older adults without dementia. Severe frailty was associated with the fewest days at home and may help to identify high-risk patients for interventions.

Abstract:

Introduction: Hip fracture is common among older adults and nearly twice as common among those with dementia,(1) who may be particularly vulnerable to its adverse effects.(2) “Days at home” is a patient-centered outcome that captures quality of life, but it has not been previously examined after hip fracture in people with dementia (PWD).


Objective: To compare days at home and survival in the year after hip fracture among older adults with and without dementia, and to identify characteristics associated with the fewest days at home in those with dementia.

Methods: This longitudinal cohort study used national administrative data from 100% of Medicare beneficiaries (2012-2021) to identify community-dwelling older adults aged ≥65 with and without dementia who were hospitalized for hip fracture. We measured survival and days at home (days alive minus days in a hospital, rehabilitation or nursing facility) over one year after hip fracture, adjusted for age and gender. P values and confidence intervals are not reported due to the whole-population design.

Results: We identified 1,756,388 older adults hospitalized for a hip fracture (mean age 82.5 years, 70.4% female]), of whom 29.2% had dementia. In the year following fracture, PWD died 70.5 days earlier than those without dementia (adjusted mean 257.4 vs. 327.9 days). Among survivors, PWD spent 54.9 fewer days at home (adjusted mean 263.3 vs. 318.2 days), due to more time in skilled nursing (38.4 vs. 24.0 days) and long-term-care facilities (52.5 vs. 12.3 days). Severe frailty was associated with the fewest days at home among PWD (adjusted mean change -33.3 days vs. absent/mild frailty).

Conclusion: PWD died approximately two months sooner and survivors spent two fewer months at home after hip fracture than those without dementia. These findings may inform advance care planning discussions and help target palliative and community resources to high-risk individuals.

References: 1. Hunt LJ, Morrison RS, Gan S, et al. Incidence of potentially disruptive medical and social events in older adults with and without dementia. J Am Geriatr Soc. May 2022;70(5):1461-1470. doi:10.1111/jgs.17682
2. Hunt LJ, Morrison RS, Gan S, et al. Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia. J Am Geriatr Soc. Apr 2025;73(4):1179-1188. doi:10.1111/jgs.19354