Changes in activity of daily living performance and quality of life 3 months after hip fracture surgery may predict 1-year surgical outcomes in Taiwanese older adults: A prospective cohort study

Abstract

Background Hip fracture is a major concern in older adults. It may result in the long-term loss of mobility and self-care ability in patients. Functional status decreases soon after hip fracture surgery but increases gradually thereafter. However, some patients may without strong physical resilience eventually exhibit functional dependence. In this study, we investigated whether short-term postoperative changes in activity of daily living (ADL) performance and quality of life (QoL) can predict the 1-year outcomes of hip fracture surgery in older Taiwanese adults. Methods This prospective cohort study included older adults (≥ 60 years) who underwent hip fracture surgery at a single tertiary medical center in Taiwan between November 2017 and March 2021. We collected baseline data, including the patients’ demographics, Charlson comorbidity index (CCI) scores, and responses to a questionnaire (Short Portable Mental State Questionnaire [SPMSQ]) for dementia screening. Moreover, their scores on the EuroQol-5D questionnaire (for evaluating QoL) and Barthel Index (for assessing ADL performance) were collected at baseline and 3 and 12 months after surgery. Changes in ADL performance and QoL 3 months after surgery were evaluated, and the associations of these parameters (and other potential factors) with 1-year surgical outcomes were investigated. Results We analyzed the data of 318 patients with hip fracture and complete follow-up data regarding ADL performance and QoL 3 and 12 months after surgery. After covariate adjustment, multivariate logistic regression revealed that changes in ADL performance and QoL 3 months after surgery were positively and significantly correlated with 1-year surgical outcomes (p < .001). Furthermore, baseline CCI and SPMSQ scores were independent predictive factors associated with 1-year ADL outcomes (p = .042 and < .001, respectively). Conclusions Short-term functional recovery may help predict long-term ADL and QoL outcomes in older adults. Thus, short-term rehabilitation programs are recommended, particularly within 3 postoperative months, to prevent long-term functional dependence. Our study may serve as a reference for future studies aimed at improving the ADL performance and QoL of older patients after hip fracture surgery.