Rehabilitation–Cognition Integrated Care Program for Elderly With Lower Limb Fractures and Cognitive Impairment: Development and Efficacy

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OBJECTIVE: To develop and assess the efficacy of a rehabilitation-cognition integrated care (RCIC) program for elderly patients with lower limb fractures and mild-to-moderate cognitive impairment. METHODS: A total of 128 eligible patients during January 2023 to December 2024 were randomly allocated to conventional (n = 64) or integrated care group (n = 64). Both groups received 12 weeks of intervention. Outcomes, including Fugl-Meyer Assessment (FMA), Berg Balance Scale (BBS), Montreal Cognitive Assessment (MoCA), Functional Independence Measure (FIM), and Hospital Anxiety and Depression Scale (HADS) scores, were compared. Serum neurotrophic and neuroinflammatory markers were analyzed pre- and post-intervention. Complications, fall recurrence rates, and nursing satisfaction were recorded. RESULTS: Post-intervention, both groups showed improved FMA, BBS, and FIM scores, with significantly greater improvement in the integrated care group (p < 0.05). HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scores decreased significantly more in the integrated care group (p < 0.05). The integrated care group demonstrated higher MoCA scores versus both its own baseline and the conventional care group post-intervention (p < 0.05). Serum BDNF and GDNF levels increased significantly in the integrated care group compared to both time-matched controls and its baseline (p < 0.05), while S100-β and IL-6 levels decreased significantly (p < 0.05). The integrated care group had lower overall complication rates (p < 0.05), comparable fall recurrence (p > 0.05), and higher nursing satisfaction (p < 0.05). CONCLUSION: The RCIC program significantly enhances motor function, balance, cognition, and psychological status while reducing complications and improving satisfaction in elderly fracture patients with cognitive impairment.

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