Dementia and hip fracture, which are increasingly common among older adults, are associated with substantial disability and mortality. These two conditions often coexist, exerting a disproportionate burden on family members. Therefore, managing the decline in cognitive function while promoting recovery after hip-fracture surgery has been an important clinical issue. At the same time, managing hipfractured patients with cognitive impairment depends on supporting their caregivers. However, very little is known about appropriately managing these patients and empowering their caregivers.

      This study aims to develop and examine an innovative family-centered intervention model for managing cognitive decline, improving postoperative recovery of hip-fractured patients with cognitive impairment, and enhancing family caregivers’ competence in dementia care. These aims thus comply with the research focus of “identifying novel strategies to prevent or treat aging related dementia” under the theme of Mental /Neurological Disorders and Aging. This care model is theoretically underpinned by: (a) the Progressively Lowered Stress Threshold Model, a component of Lawton’s ecological model of aging, and (b) the concept of partnership with family caregivers to strengthen their competence in providing care. Different from our prior developed interdisciplinary care model for patients with hip fracture, key elements of this care model will include involvement of family caregivers in geriatric assessment, continuous rehabilitation, and enhanced discharge service. In addition, training will be provided to family caregivers to enhance their competence in caring for hip-fractured patients with cognitive impairment.

      The effectiveness of the proposed family-centered care model will be evaluated in a randomized controlled trial. Hip-fractured patients with cognitive impairment and their caregivers (N=152) will be recruited from the emergency rooms of Chang Gung Memorial Hospital (CGMH) at Linkou. Within 1 day of entering the emergency room, patients will be randomly assigned to either an experimental group (family-centered care) or a control group (usual care).

      Primary outcomes include patients’ cognitive function, clinical measures (e.g., rehabilitation outcomes, complications, recurrence of falls), and self-care ability. In addition, family caregivers’ competence and preparedness will be assessed. Secondary outcomes consist of health service utilization, quality of life, and cost of care. Outcome measures will be collected at 1, 3, 6, and 12 months after hospital discharge. The clinical effectiveness of the proposed family-centered care model will be evaluated by hierarchical linear models. Equally important, the proposed care model will be evaluated for cost-effectiveness. Cost-effectiveness will be analyzed from the perspectives of the health care system and society. Actual costs will be obtained from the hospital accounting system, the National Health Insurance payment database, patient self-report, and data from published and unpublished sources. The proposed study has been approved by the Institutional Review Board of CGMH.

      This research will provide important knowledge about managing older adults’ comorbidities (i.e., hip fracture and dementia) and its cost-effectiveness, which may lead to improved clinical practice and decision making for health care policy. More importantly, the proposed study may serve as a foundation for designing further clinical protocols for managing older persons with cognitive impairment and other disabilities.