Dynamics of Multimorbidity and Physical Resilience in Persons with Dementia after Hip Fracture in Long-Term Care Facilities

Abstract

Older persons with dementia are disproportionately affected by acute injuries such as a hip fracture and they experience significantly worse recovery outcomes than their peers without dementia. The overarching goal of this dissertation is to delineate physical function recovery trajectories after hip fracture in persons with dementia and examine how recovery is affected by multimorbidity, through the lens of physical resilience. This dissertation comprises five chapters designed to: 1) introduce the scope of the problem of recovery from hip fracture among older adults with dementia, 2) identify gaps in knowledge by conducting scoping review on health recovery trajectories in older adults after hip fracture, 3) delineate trajectories of physical function recovery and examine patient characteristics associated with membership of physical function trajectory categories in a national sample of 16,255 older adults with dementia residing in long-term care facilities for one year, 4) examine the longitudinal mediation effects of severity of behavioral symptoms between level of cognitive impairment and physical function recovery and the moderation effects of vision loss among a subset of long-stay nursing home residents with dementia and behavioral symptoms following hip fracture (n=2,824), and 5) summarize conclusions and implications for research, practice, and policy. Five heterogeneous trajectories of recovery of activities of daily living and three trajectories of range of motion were described, along with clinical and sociodemographic factors associated with membership in each category. Among the subset of residents with behavioral symptoms after hip fracture, behavioral symptoms were a partial mediator with a small effect size; vision loss did not moderate these relationships. The findings of this dissertation project contribute new knowledge regarding how older adults with dementia recover physical function (physical resilience) and how their recovery relates to symptoms caused by dementia and vision loss after hip fracture. These findings provide a novel empirical foundation for clinicians to improve individualized care plans based on predicted trajectories of recovery for those with dementia after hip fracture.