Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture

Objectives This study examines the effects of depression and cognitive impairment in elderly hip fracture patients receiving inpatient rehabilitation. Our goal was to determine whether any association of depression and cognitive impairment with rehabilitation outcome is accounted for by more immediate effects of these variables on rehabilitation participation. Methods We measured depression using the Hamilton Rating Scale for Depression (Ham‐D), cognition using the Mini Mental State Examination (MMSE), and rehabilitation outcomes using the motor scale of the Functional Independence Measure (motor FIM) in a prospective observational study of 57 elderly rehabilitation hospital patients admitted to a university‐affiliated, freestanding rehabilitation hospital with primary diagnosis of hip fracture. We also assessed rehabilitation participation, to determine whether this accounted for (mediated) any relationship of depression and cognitive impairment with rehabilitation outcome. Results Baseline Ham‐D and MMSE scores were correlated with motor FIM efficiency—those with higher depressive symptoms had lower efficiency (r = −0.44, p