Home visits help hip fracture patients

Hip fracture patients who have a home visit with an occupational therapist prior to leaving hospital have fewer readmissions and more functional independence after three months than those who don’t.

Older hip fracture patients who have a home visit with an occupational therapist prior to leaving hospital have “significantly” fewer readmissions and more functional independence after three months than those who don’t, research has found.

They also receive more recommendations about home modifications and are more likely to comply with them.

Kylee Lockwood

It is standard practice for people who have had a hip fracture to receive rehabilitation and education in the hospital setting, but it’s less common for them to have a home visit before being discharged from hospital.

Kylee Lockwood from the School of Allied Health at La Trobe University conducted a trial of pre-discharge home visits by OTs for patients with a hip fracture to find out if this was beneficial.

She discussed the results at Occupational Therapy Australia’s national conference this month.

The study

The study, published in the journal Clinical Rehabilitation in January, involved Melbourne’s Eastern Health service and involved 77 people aged over 50 who had been admitted to hospital with a hip fracture.

They were divided into two groups, both of which got assessment, education and recommendations while in hospital.

The intervention group also received a single OT home visit with the participant and their family prior to discharge.

The patients were followed up after 30 days and six months.

During the home visit, OTs assessed mobility, self-care and household safety, and provided education and advice on home modifications and community support services.

In the first thirty days, the intervention group had six falls, while the control group reported 14, although by six months the results were similar in both groups.

The study also found participants who were involved in a home visit had better functional independence at six months.

Home modifications

The study also investigated the number and type of home modification recommendations made during a pre-discharge home visit compared to a hospital based assessment, and how well the recommendations were followed.

On average, the home visit group received almost three more recommendations (2.8) than the hospital group, including recommendations about assistive technology and task modification, and were more likely to adhere to them.

This could have contributed to the reduced rate of hospital readmissions for the home visit group, Ms Lockwood said.

“What we found was that adherence to home modification recommendations was a mediator in the relationship between participants’ involvement in a home visit and reduced readmissions to hospital.

“It suggests that home visits were effective in reducing readmissions to hospital at least in part by improving adherence to the home modification recommendations.”

Implications for clinical practice

Based on the results of her study, Ms Lockwood said hip fracture patients should have a home visit prior to discharge from hospital where possible.

“The results show that participating in a home visit prior to discharge reduces the risk of readmission to hospital, increased functional independence at 6 months, and is likely to have reduced the number of falls in the first 30 days,” she said.

She said the results suggest  that a home visit for a patient who is recovering from a hip fracture provides a better context for patient, carer and OT and can bridge the gap between hospital and home,  as well as helping boost confidence and providing tools to help manage daily activities.

“A home visit isn’t simply an assessment, but directs a management plan for the older person which leads to tangible interventions to support an older person returning home to community living,” she said.

Economic evaluation

Ms Lockwood says a full economic analysis of pre-discharge home visits is required because they are very resource-intensive, and it is still to be determined whether the costs are offset by potential savings on  hospital readmissions and related care.

“However it does appear likely that pre-discharge home visits may be cost effective in this population,” she said.

Some 23,000 Australians suffer a hip fracture each year, and 60 people fracture a hip each day, with transition from hospital to home presenting significant challenges for older people and their carers.

By six months more than half of hip fracture patients have not regained the ability to complete basic tasks and only one in 10 regain previous mobility.

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