Multidisciplinary Perioperative and Post-Acute Care for Older Adults with Hip Fracture and Cognitive Impairment or Dementia: A Narrative Review.
- 1Department of Spine and Joint Surgery, Zibo First Hospital, Zibo, Shandong, People's Republic of China.
Abstract
Hip fracture care becomes more complex when an older adult has cognitive impairment. Pain may be expressed behaviorally, consent and goals of care may require supported decision-making, delirium can be difficult to distinguish from baseline impairment, and rehabilitation must accommodate altered learning and communication. Unlike reviews focused predominantly on individual management domains, this narrative review integrates evidence across the entire care pathway, from emergency assessment and perioperative management to inpatient care, post-acute rehabilitation, and discharge planning, with particular emphasis on how cognitive impairment affects care coordination and continuity. The most consistent priorities are timely surgery after correction of reversible instability, reliable recognition and treatment of pain and delirium, early supported activity, and access to rehabilitation adapted to the person's abilities. Cognitive impairment changes how these elements are delivered; it is not, by itself, a reason to withhold them. Decisions about discharge and longer-term recovery are better anchored in prefracture function, transfer ability, residence, caregiver capacity, and the patient's goals than in a cognitive label alone. In advanced dementia, operative and non-operative management are both active care pathways and require explicit discussion of comfort, transfers, nursing burden, survival, and previously expressed values. Direct evidence is most limited for patients with moderate or severe dementia, who are commonly excluded from trials despite being among those most vulnerable to gaps in care.
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BibTeX
@article{han2026multidisciplinary,
title = {{Multidisciplinary Perioperative and Post-Acute Care for Older Adults with Hip Fracture and Cognitive Impairment or Dementia: A Narrative Review.}},
author = {Xinxin Han and Wenzhe Han and Xuchen Yin and Miaomiao Li},
journal = {Journal of multidisciplinary healthcare},
year = {2026},
month = oct,
doi = {10.2147/jmdh.s659380},
url = {https://europepmc.org/article/MED/42968950},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Multidisciplinary Perioperative and Post-Acute Care for Older Adults with Hip Fracture and Cognitive Impairment or Dementia: A Narrative Review.
AU - Xinxin Han
AU - Wenzhe Han
AU - Xuchen Yin
AU - Miaomiao Li
PY - 2026
DA - 2026/10/28
JO - Journal of multidisciplinary healthcare
DO - 10.2147/jmdh.s659380
UR - https://europepmc.org/article/MED/42968950
AB - Hip fracture care becomes more complex when an older adult has cognitive impairment. Pain may be expressed behaviorally, consent and goals of care may require supported decision-making, delirium can be difficult to distinguish from baseline impairment, and rehabilitation must accommodate altered learning and communication. Unlike reviews focused predominantly on individual management domains, this narrative review integrates evidence across the entire care pathway, from emergency assessment and perioperative management to inpatient care, post-acute rehabilitation, and discharge planning, with particular emphasis on how cognitive impairment affects care coordination and continuity. The most consistent priorities are timely surgery after correction of reversible instability, reliable recognition and treatment of pain and delirium, early supported activity, and access to rehabilitation adapted to the person's abilities. Cognitive impairment changes how these elements are delivered; it is not, by itself, a reason to withhold them. Decisions about discharge and longer-term recovery are better anchored in prefracture function, transfer ability, residence, caregiver capacity, and the patient's goals than in a cognitive label alone. In advanced dementia, operative and non-operative management are both active care pathways and require explicit discussion of comfort, transfers, nursing burden, survival, and previously expressed values. Direct evidence is most limited for patients with moderate or severe dementia, who are commonly excluded from trials despite being among those most vulnerable to gaps in care.
SN - 1178-2390
ER -