Equity of Multidisciplinary Hip-Fracture Care in Patients With Dementia: Time-to-Theatre and Discharge Outcomes: A Retrospective Cohort Study

Background Cognitive impairment is common among hip fracture patients and may influence care and outcomes. We evaluated whether patients with dementia or delirium receive equitable multidisciplinary hip-fracture care compared with cognitively intact patients, focusing on surgical timing and discharge outcomes. Methods From 775 admissions, we retrospectively reviewed a random sample of 382 cases (January 2024-June 2025) at Southend University Hospital, stratifying into impaired (dementia, suspected cognitive decline, or delirium on admission; n=191) and non-impaired (normal cognition on Abbreviated Mental Test Score [AMTS]/4AT; n=191) groups. Using the National Hip Fracture Database, we collected data on time-to-surgery, orthogeriatric review, preoperative 4AT, physiotherapy and mobilisation, pain management, communication support, carer involvement, do not attempt cardiopulmonary resuscitation (DNACPR) documentation, discharge destinations, and in-hospital mortality. Outcomes were compared using chi-square for categorical data and t-test or Mann-Whitney for continuous data, with p<0.05 significant. Results Impaired patients experienced longer delays to theatre (median 35.3 h [IQR 23.0-48.7] vs. 29.8 h [20.6-43.8]; mean 44.9±36.0 vs. 36.5±32.3; p=0.029). Time to orthogeriatric review was similar (median ~21 h in both). Not all impaired patients had 4AT ≥4, but the median was higher in the impaired group (4 vs. 0). Impaired patients were less likely to return home (52.7% vs. 84.4%, p<0.001), more often discharged to residential care (35.3% vs. 7.5%), and had higher in-hospital mortality (8.7% vs. 2.7%, p=0.02). Physiotherapy assessment rates were high (>97%), but early mobilisation was lower in impaired patients (81.6% vs. 89.9%, p=0.04), with agitation frequently noted as a barrier. Analgesic prescribing was similar, but the qualitative review suggested undertreatment in impaired patients. Conclusions Patients with cognitive impairment experienced slower access to theatre, reduced early mobilisation, a lower likelihood of discharge home, and higher in-hospital mortality. Dementia-informed adjustments, such as fast-track surgery, validated pain tools, delirium-prevention bundles, carer engagement, and strengthened rehabilitation, are warranted to deliver equitable hip-fracture care.