The HipCog Study: evaluating the impact of cognitive impairment on outcomes for older adults with hip fracture

Background: Over 3800 older people in Ireland experience hip fracture annually. These serious events have a one-year mortality rate of 20%. Since 2012, the Irish Hip Fracture Database (IHFD) has driven national clinical improvement and reduced variability of care across hospitals. While hospital-level care variation has decreased, it is unknown if cognitively vulnerable patients receive equitable treatment. More than one third of hip fracture patients have cognitive impairment. Given that the number of people with cognitive impairment/dementia and hip fracture will increase over the next 25 years, there is a critical need to ensure equitable care for this vulnerable cohort.

Aim: This project aims to evaluate the quality of care following hip fracture for people with cognitive impairment (including delirium) or dementia from the acute setting through to intermediate/community rehabilitation to inform strategic planning of services for this cohort.

Design: These aims will be addressed through three inter-related Work Packages (WP):

WP1: The most appropriate screening test for cognitive impairment and delirium at different points of acute care will be identified through comparative diagnostic test accuracy review of screening tools. Barriers and facilitators to cognitive/delirium screening will be explored through qualitative interviews with healthcare professionals. 
WP2: National analysis of variations of current hip fracture care quality indicators based on patients’ cognitive status will be conducted. Existing multivariable prediction models for long-term care admission and mortality among older adults with a hip fracture will be explored within the IHFD dataset.
WP3: An evaluation of the mechanisms underpinning rehabilitation post-hip fracture for people with cognitive impairment will be conducted to determine effective components of intervention delivery. Current early supported discharge for people with dementia following hip fracture will be evaluated through a mixed methods multi-site case study.

Impact: These findings will inform hip fracture care planning for cognitively vulnerable older adults.

Award Date: 22 September 2023
Award Value: €264,191.07
Principal Investigator: Dr Niamh Merriman
Host Institution: University College Dublin
Scheme: HRB Postdoctoral Fellowships: ARPP 2023