SUMMARY POINTS

[bull ] Geriatric service interventions after hip fracture are complex and strongly influenced by local conditions. The effectiveness of rehabilitation programs is uncertain, and comparative studies comparing different treatments and strategies are of poor to moderate quality.

[bull ] Based on the available evidence, geriatric hip fracture and early supported discharge programs are probably cost-effective since they appear to shorten the average length of hospital stay and are associated with significantly increased rates of return to previous residential status. Clinical pathways also appear to reduce total length of stay in hospital.

[bull ] Geriatric orthopedic rehabilitation units are unlikely to be cost-effective, but some frailer patients may benefit in respect of reduced readmission rates and need for nursing home placement.

[bull ] Length of stay may be reduced by the introduction of prospective payment systems, but these have led to increased use of nursing homes in the United States.

[bull ] There is no evidence that any of the programs evaluated are associated with changes in mortality. However, there are insufficient data to assess the impact of any program on level of function, morbidity, quality of life, or impact on carers.