It is estimated that there are 320,000 hip fractures in the U.S. and that 15-30% of hip fracture patients have Alzheimer's disease and related dementias (ADRD) at the time of the fracture. While many individuals with ADRD return home, there are several caregiving challenges. Hip fracture patients with ADRD are likely to experience depression, apathy, and other behavioral symptoms, which may increase resistance to care, and create additional care burden for family caregivers. Most intervention research specifically excludes patients with ADRD, a group with poor outcomes after hip fracture. The purpose of this study is to test the feasibility and impact of a home-based intervention specifically designed to improve physical and psychosocial outcomes those with ADRD who suffer a hip fracture and their caregivers. There is a critical need for practical interventions prevent excess disability and minimize behavioral symptoms among hip fracture patients with ADRD who return home.
The specific aims of this study are to: 1. Pilot test a home-based 8-week dementia-specific functionally-based graduated caregiver-involved intervention, ?Function Focused Care for the Cognitively Impaired: Hip Care at Home (FFC-HC)?, in hip fracture patients with ADRD who return to the community with family caregivers after discharge from post- acute (customary) rehabilitation care; 2. Evaluate the 2-month improvement in patient outcomes, including Activities of Daily Living (ADL), physical performance and activity, and behavioral and affective symptoms (including resistance to care); and 3. Evaluate the 2-month improvement in caregiver knowledge, beliefs (self-efficacy and outcome expectations), performance of FFC, burden, depression, and fear of falling (regarding their family member). The data will be used to plan a larger RCT that could answer the fundamental question of whether those with ADRD require a different approach, which is more functionally based, ADRD sensitive, and includes motivation for both the patients and their caregivers to maximize and maintain recovery.
Patients with Alzheimer's Disease and related dementias often fracture their hip, and they may not recover as well and their caregivers do not get the support they need when they return home. This study tests a new way to help hip fracture patients with ADRD and their caregivers. The information learned in this small study will be used to design a larger study to test whether the intervention works.
