Function Focused Care: Hip Care at Home

Prior research by the Baltimore Hip Studies (BHS) has shown that it is possible to improve
function, increase physical activity, and improve behavioral symptoms among long term care
residents with ADRD and to effectively coach and mentor caregivers through a care practice,
Function Focused Care for the Cognitively Impaired (FFC-CI), that focuses on having
caregivers teach, cue, model, and assist cognitively impaired individuals to perform
functional tasks and engage in physical activity, while minimizing behavioral symptoms. This
study will determine if a revised intervention, Function Focused Care for the Cognitively
Impaired: Hip Care at Home (aka, Hip Care at Home), can be implemented in a home setting.

The Hip Care at Home intervention will include an initial evaluation of the hip fracture
participant, caregiver, and home setting by an interdisciplinary care team including a
physical therapist (PT), occupational therapist (OT), and a coach (nurse or nurse's aide)
trained in the function focused care (FFC) approach. The FFC coach will then work with the
primary informal (family or friend, unpaid) caregiver to integrate the recommended
environmental, behavioral, and physical interventions into the home setting, with weekly
visits.

HIP FRACTURE PARTICIPANTS

Inclusion Criteria:

- Hip fracture

- Pre-fracture diagnosis of Alzheimer's disease or related dementia

- Age 65+ at time of fracture

- Had surgical repair for the hip fracture

- Completed usual rehabilitation

- Discharged to the community after rehabilitation ends (i.e., private home or assisted
living)

- Availability of a caregiver (i.e., family relative or non-relative, unpaid, informal)
providing ADL or IADL care or oversight at least weekly

Exclusion Criteria:

- Pathologic fracture

- Not community-dwelling (e.g., nursing home resident) prior to fracture

- Bedbound during the 6 months prior to fracture

- No caregiver or caregiver refuses study participation

- Not authorized by a physician to participate in an exercise or rehabilitation program
prior to starting the intervention

- Not returning to the community before 180 days post-hospital discharge (can go to
assisted living)

CAREGIVER PARTICIPANTS

Inclusion Criteria:

- Identified as a caregiver (i.e., family relative or non-relative, unpaid, informal)
who will help or supervise the hip fracture participant with ADL or IADL tasks after
discharge from rehab

- Helping or supervising the hip fracture participant with one or more ADL or IADL tasks
at least weekly when screened for this study OR plans to be the primary person
providing care at least weekly after the hip fracture participant is discharged from
rehab

Exclusion Criteria:

- Not English speaking

- Living more than 40 miles from the hip fracture participant

- Unable to provide informed consent