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Rehabilitating Patients With Dementia Who Have Had a Hip Fracture: Part IBehavioral Symptoms That Influence Care

McGilton, Katherine PhD, RN; Wells, Jennie MD; Teare, Gary PhD; Davis, Aileen PhD; Rochon, Elizabeth PhD; Calabrese, Sue MN, RN; Naglie, Gary MD; Boscart, Veronique MN, RN

Topics in Geriatric Rehabilitation: April-June 2007 - Volume 23 - Issue 2 - p 161–173
doi: 10.1097/01.TGR.0000270185.98402.a6

Objective Although evidence suggests that patients with cognitive impairment can benefit from rehabilitation, healthcare professionals (HCPs) on geriatric rehabilitation units (GRUs) often find that providing care to these patients following a hip fracture can be challenging. The objective of this study was to identify the behavioral symptoms that HCPs find difficult to manage in patients with dementia who have had a hip fracture and the strategies that they report using when patients exhibit these symptoms.

Subjects and Methods One hundred thirty-three HCPs responsible for providing direct rehabilitation care in 7 GRUs in Ontario, Canada, completed a questionnaire. The questionnaire collected data on the frequency of behavioral symptoms that persons with dementia experienced after hip fracture surgery and on the strategies HCPs used to manage these symptoms.

Results The data collected indicate that HCPs perceived patients' anxiety, agitation, and irritability to be the main behavioral symptoms that interfere with their ability to deliver rehabilitation care. HCPs perceived that patients' behaviors occurred frequently enough to influence rehabilitation care, however, only 51% of nursing staff listed strategies they used when patients exhibited behavioral symptoms, whereas as many as 96% of allied HCPs listed strategies. When clients had symptoms, staff used assessment and intervention strategies, which included both nonpharmacological and pharmacological ones.

Conclusions The findings from this study indicate that HCPs caring for persons with dementia who are rehabilitated after a hip fracture surgery on GRUs, frequently encounter behavioral symptoms that hinder their care delivery.

Toronto Rehabilitation Institute (Drs McGilton, Rochon, and Naglie, and Ms Boscart), Toronto, Ontario; the Division of Geriatric Medicine, University of Western Ontario, London, Ontario (Dr Wells); the Quality Measurement and Analysis Health Quality Council, Saskatoon, Saskatchewan (Dr Teare); the Division of Health Care and Outcomes Research, Toronto Western Research Institute, Toronto, Ontario (Dr Davis); the Departments of Speech-Language Pathology (Dr Rochon), and Medicine and Health Policy, Management and Evaluation (Dr Naglie), University of Toronto, Toronto, Ontario; the Faculty of Nursing, Ryerson University, Toronto, Ontario (Ms Calabrese); and the University Health Network, Toronto, Ontario (Dr Naglie), Canada.

Corresponding author: Katherine McGilton PhD, RN, Toronto Rehabilitation Institute, Queen Elizabeth Centre, 130 Dunn Ave, Toronto, Ontario, Canada M6K 2R7 (e-mail:

This research was funded by the Toronto Rehabilitation Institute, the Ontario Rehabilitation Research Network, and the Ontario Ministry of Health and Long-term Care.

© 2007 Lippincott Williams & Wilkins, Inc.