GR-HIP: Geriatric Rehabilitation of patients after HIP fracture; functioning and burden of patients and primary caregivers after hip fracture.

Background: Hip fracture is a major cause for mortality and morbidity in elderly persons, with a 25% mortality rate and only 40-60% chance of complete functional recovery in the first year after fracture. Patients with hip fracture have a mean age of 79 years, almost 75% of the patients are women, nearly 70% has at least two chronic illnesses, and they experience on average 3 complications. After the acute hospital phase, patients that had a previously independent living situation are either discharged home or to inpatient geriatric rehabilitation (GR) in postacute GR wards where they are treated by a multidisciplinary team consisting of an elderly care physician, physical therapist, occupational therapist, psychologist, and skilled nurses. Currently, there are no clear guidelines determining type, quality, or intensity of training during rehabilitation admission. Also, the effect of quality and intensity of treatment as well as important (age-related) characteristics on functional outcome and quality of life are not known. In this study, we aim to determine which variables predict successful as well as non-successful rehabilitation and explore effective treatment programmes with the purpose of developing good practice care-pathways. In order to develop these care-pathways, it is important to gather information on patient-related factors, healthcare use during and after admission to postacute GR wards as well as caregiver burden and quality of life. Methods: The design has a mixed-methods approach with a large inception cohort and qualitative data-collection from elderly care physicians, physical therapists, patients, and primary caregivers. Patients will be included in the acute phase after hospital admission at Bronovo Hospital, the Hague, for hip fracture and they will be followed-up at six weeks, three and twelve months in the outpatient clinic. Patients are invited for this outpatient hip fracture clinic as part of regular patient care, where standard assessments take place. The follow-up encompasses assessment instruments for patients and questionnaires for patients as well as primary caregivers. Patients that are not able to visit the outpatient clinic will be followed up by research nurses in their place of residence. Data that will be collected are: patient and caregiver characteristics, comorbidity, functional abilities (Harris Hip Score, Katz ADL, actual activities undertaken measured with accelerometers), cognitive abilities, quality of life, measures on sarcopenia (fat-free mass, hand-grip force, gait speed, risk of malnutrition), healthcare-use, psychological measures on coping and (proxy) fear of falling, and caregiver burden. Relevance: This research , which is twinned with the HOME-HIP, a research proposal for the ‘family medicine’ part of HGOG grant, will provide information needed to create good practice care- pathways and provide a basis for interventions aimed at increasing recovery potential and quality of life after hip fracture in this vulnerable group of patients. Elderly persons, ie patients, caregivers and consultants (a member of the elderly advisory board will be involved in developing the qualitative part of the study) will be actively involved in constructing these pathways. This will lead to adherence to wishes, expectations, and priorities in rehabilitation after hip fracture. Expertise: The research will be embedded in the research program geriatrics in primary care, which is a close collaboration between the department of primary care and elderly care (PHEG-AGE). This program focuses on the prevention of decline and improving of functioning and quality of life of vulnerable older persons. The overall aim is to improve (the organization of) medical care for all older persons outside the hospital (in community and in institutional care) by building up scientific knowledge and evidence. Improvement of quality of life and maintenance of independency in daily functioning of older people is the main starting point of our research, with perspectives of older people as a guide. PHEG-AGE has a strong collaboration with the professional associations of general practitioners (GP) and elderly care physicians (ECP), as well as Boerhaave post-graduate education, and other educational institutes to communicate the results of this study. The researchers of PHEG-AGE also revise teaching modules for the GP and ECP theoretical training, allowing for integration of research results from these studies in the training programme. The study will in addition be co-supervised by researchers from the Maastricht University Medical Center.