Clemens Becker, Kilian Rapp, Dietrich Rothenbacher, Claudia Schulz, Hans-Helmut König, Gisela Büchele
Department of Clinical Gerontology, Robert-Bosch-Hospital , Stuttgart, Germany. E-mail: clemens.becker@rbk.de
DOI: 10.2340/16501977-2630

Objective: Acute geriatric care (geriatric early rehabilitative treatment) and sub-acute (inpatient) geriat-ric rehabilitation are delivered to geriatric patients in Germany after hip fracture. The aim of this study was to compare patients’ outcomes after hip fracture between 3 German federal states (Hesse, Bavaria, and Baden-Wuerttemberg) that nearly exclusively offered one of the two geriatric care systems.
Design: Retrospective cohort study with patient-related health insurance claims data.
Patients: Analyses were performed with data from 2009–2012 of over 30,000 patients aged ≥80 years with incident hip fracture.
Methods: Primary outcomes: “increase in care dependency”, “nursing home admission”; secondary outcomes: “rehospitalization”, “mortality”. Multivariate regression models were applied.
Results: Compared with Hesse, the state with acute geriatric care, the risks of an “increase in care dependency” were lower in Bavaria (adjusted ratio = 0. 84; 95% confidence interval (95% CI) 0. 81–0. 87) and Baden-Wurttemberg (0. 88; 0. 85–0. 92), the 2 federal states with sub-acute geriatric rehabilitation. A reduction in the risk of nursing home admission was observed in Baden-Wuerttemberg (0. 77; 95% CI 0. 69–0. 87), but not in Bavaria. Rehospitalization rates were lower in Bavaria and Baden-Wuerttemberg compared with Hesse. There was no difference in mortality.
Conclusion: Some, but not all, outcomes were more favourable in the federal states with sub-acute geriatric rehabilitation than in the federal state with acute geriatric care.

In Germany, acute geriatric care and sub-acute geriatric rehabilitation are delivered to older patients after hip fracture. The aim of this study was to determine whether one of the two systems is superior regarding the outcomes “increase in care dependency”, “nursing home admission”, “rehospitalization” and “mortality”. Therefore, these outcomes were compared in hip fracture patients treated in 3 different federal states (Hesse, Bavaria and Baden-Wuerttemberg), which nearly exclusively offered one of the two geriatric care systems. Compared with Hesse (acute geriatric care), the risks of an “increase in care dependency” and of rehospitalization were lower in Bavaria and Baden-Wurttemberg (states with sub-acute geriatric rehabilitation) then in Hesse. A reduction in the risk of nursing home admission was observed in Baden-Wuerttemberg, but not in Bavaria. There was no difference in mortality between the 3 states. In conclusion some, but not all, outcomes were more favourable in the federal states with sub-acute geriatric rehabilitation than in the federal state with acute geriatric care.

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