Prevalence of Dementia and Cognitive Impairment Among Older Adults With Hip Fractures

Background Dementia and cognitive impairment are known to be risk factors for hip fractures and are associated with increased postoperative morbidity and mortality. Little is known of the prevalence of dementia and cognitive impairment among older adults with hip fractures. Methods We completed searches of the electronic databases for observational studies and report the prevalence of either dementia or cognitive impairment among individuals with hip fractures. We included studies that reported the prevalence of dementia using standard diagnostic criteria or cognitive impairment as measured on cognitive screening tests. We used random-effects meta-analysis to arrive at pooled estimates of the prevalence of dementia and cognitive impairment. Results Five studies reported the prevalence of dementia and 34 studies reported the prevalence of cognitive impairment in older adults with hip fractures. The estimated prevalence of dementia among older adults with hip fractures was 19.2% (95% confidence interval [CI]: 11.4% to 30.6%), whereas the prevalence of cognitive impairment was 41.8% (95% CI: 37.0% to 46.8%). In subgroup analyses, individuals admitted from long-term care were more likely to have dementia when compared with individuals admitted from the community, whereas there were no significant differences in the prevalence of cognitive impairment according to gender or study setting. Conclusions We conclude that dementia and cognitive impairment are common among older adults with hip fractures. Clinicians providing care for individuals with hip fractures should be aware of the high prevalence of cognitive impairment in this population. Effective strategies to prevent hip fractures and improve postoperative outcomes for older adults with dementia are needed. Dementia and cognitive impairment are known to be risk factors for hip fractures and are associated with increased postoperative morbidity and mortality. Little is known of the prevalence of dementia and cognitive impairment among older adults with hip fractures. We completed searches of the electronic databases for observational studies and report the prevalence of either dementia or cognitive impairment among individuals with hip fractures. We included studies that reported the prevalence of dementia using standard diagnostic criteria or cognitive impairment as measured on cognitive screening tests. We used random-effects meta-analysis to arrive at pooled estimates of the prevalence of dementia and cognitive impairment. Five studies reported the prevalence of dementia and 34 studies reported the prevalence of cognitive impairment in older adults with hip fractures. The estimated prevalence of dementia among older adults with hip fractures was 19.2% (95% confidence interval [CI]: 11.4% to 30.6%), whereas the prevalence of cognitive impairment was 41.8% (95% CI: 37.0% to 46.8%). In subgroup analyses, individuals admitted from long-term care were more likely to have dementia when compared with individuals admitted from the community, whereas there were no significant differences in the prevalence of cognitive impairment according to gender or study setting. We conclude that dementia and cognitive impairment are common among older adults with hip fractures. Clinicians providing care for individuals with hip fractures should be aware of the high prevalence of cognitive impairment in this population. Effective strategies to prevent hip fractures and improve postoperative outcomes for older adults with dementia are needed.