Bone Abstracts

Objective: From April 2012, pre- and post-operative cognitive assessment amongst hip fracture patients is one of the criteria for enhanced payment to hospitals in England in UK. Aim of the study was to assess the prevalence of dementia amongst hip fractures and assessments from specialist mental health services.

Methods: Prospective study.

Setting: Acute hip unit at a UK hospital in Wales(not England).

Subjects: Patients admitted following hip fractures.

A single researcher collected data on the prevalence of dementia and mild cognitive impairment (MCI) amongst hip fracture patients after their surgery just before discharge using MMSE and 6CIT cognitive assessments scales.

Results: Age range 65–94 years 70% females.

Total number of study population=80.

The prevalence of dementia amongst older hip fracture patients was 26%. The prevalence of mild cognitive impairment was 42%. No significant differences in the prevalence of dementia or cognitive impairment was noted between the sexes. Patients from long-term care setting were significantly more likely to have dementia (49%) compared to those admitted from the community (18%). 40% of patients had a documented past history of dementia and 25% of these were on dementia medications. Despite access to specialist mental health services, only 15% patients were referred/assessed by specialist Mental Liaison team.

Conclusions: A significant proportion of elderly hip fracture patients have cognitive impairment and dementia, many are previously undiagnosed. These patients would benefit from further detailed assessment from LIAISON Psychiatry team following initial diagnosis. Our findings suggest need for improved staff awareness and training to detect dementia early, to ensure that hospitals have a care pathway in place for dementia that fits with existing acute care pathways. Improved diagnosis and management for this high risk group has potential implications in reducing length of stay not only in acute hospital but also the overall burden of dementia after discharge.