Association between cognitive impairment and repeat fractures in Medicare beneficiaries recently hospitalized for hip fracture.

BACKGROUND: Repeat fractures contribute substantially to fracture incidents in older adults. We examined the association between cognitive impairment and re-fractures during the first 90 days after older adults with hip fractures were discharged home from a skilled nursing facility rehabilitation short stay.

METHODS: Multilevel binary logistic regression was used to analyze 100% of US national post-acute-care fee-for-service Medicare beneficiaries who: had a hospital admission for hip fracture from 2018/01/01 to 2018/07/31; were admitted for a skilled nursing facility stay within 30 days of hospital discharge; and were discharged to the community after a short stay. Our primary outcome was rehospitalization for any re-fractures within 90 days of skilled nursing facility discharge. Cognitive status assessed at skilled nursing facility admission or before discharge was classified as either intact or having mild or moderate/severe impairment.

RESULTS: In 29,558 beneficiaries with hip fracture, odds of any re-fracture were higher in those with minor (odds ratio: 1.48; 95% confidence interval: 1.19 to 1.85; p<.01) and moderate/major cognitive impairment (odds ratio: 1.42; 95% confidence interval: 1.07 to 1.89; p=.0149) than in those classified as intact.

CONCLUSIONS: Beneficiaries with cognitive impairment were more likely than their counterparts with no cognitive impairment to experience re-fractures. Community-dwelling older adults with minor cognitive impairment may experience a higher likelihood of experiencing a repeat fracture leading to rehospitalization.