Prognostic indicators and early home rehabilitation in elderly patients with hip fractures.

A program for early mobilization in the hospital and rehabilitation at home after hip fracture was developed in cooperation with local health and social authorities and applied to 103 consecutive patients having a mean age of 75 years. All were admitted to the hospital from their own homes. Three fourths of the patients returned home directly after postoperative mobilization periods of usually two to three weeks in hospital. Four months after the fracture 81 of 99 surviving patients were at home, most of them having regained their prefracture functional status. One year after the fracture 91 patients were alive, and 78 of these were at home with no functional loss, compared with their condition at four months. Some of the social and medical factors which may already be pertinent to the recovery outcome at the time of fracture are identified. Eight to nine of ten patients with two or three positive factors ("healthy," living with someone, and ability to walk two weeks postsurgery) returned directly home. This study suggests the importance of intensive support, in the form of information to patients and relatives, and close cooperation between hospital staff and community care authorities. By this means, a continuity of care and early permanent independence can be achieved for elderly hip fracture patients and institutionalized rehabilitation can be reduced with benefit for both the individual and society.