Determinants of functional outcome in hip fracture patients: the role of specific neuropsychiatric symptoms

Gialanella, Bernardo; Ferlucci, Cristina; Monguzzi, Vittoria; Prometti, Paola

doi:10.3109/09638288.2014.932446

Cited by 17 publications

(18 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our findings are consistent with previous studies showing that cognitive impairment and depressive symptomatology predicted poor rehabilitation [ 7 , 50 , 51 ]. Similarly, in one cohort of 459 older patients hospitalized in a general medical service, risk of 1-month functional decline was two- to three-fold higher for patients with depression, delirium or with the overlap syndrome of depression and delirium than patients with neither depression nor delirium [ 52 ].…”

Section: Discussionsupporting

confidence: 93%

Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

et al. 2020

View full text Add to dashboard Cite

Background In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods We used a prospective cohort of consecutive patients aged ≥75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results Among the 252 eligible patients, 160 (median age 84 years [interquartile range (IQR) 80–88] had available ADL scores at baseline (median score 7 [IQR 4–10]) and at discharge (median 9 [6–12]). Median CIRS-G score was 11 [8–13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P = 0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P = 0.02, or psychiatric disease, P = 0.02) and albumin level < 35 g/l (p = 0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27–7.41], p = 0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17–8.32],p = 0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4–37.7], p = 0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83–6.16], p = 0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

show abstract

Section: Discussionsupporting

confidence: 93%

Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Our findings are consistent with previous studies showing that cognitive impairment and depressive symptomatology predicted poor rehabilitation (7,43,44). Similarly, in one cohort of 459 older patients hospitalized in a general medical service, risk of 1-month functional decline was two-to three-fold higher for patients with depression, delirium or with the overlap syndrome of depression and delirium than patients with neither depression nor delirium 45The CIRS-G ≥ 2 for respiratory diseases was associated with functional decline and with pulmonary HAI.…”

Section: Discussionsupporting

confidence: 93%

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

Laurent

Oubaya

Poitrine

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. Methods: We used a prospective cohort of consecutive patients aged ≥ 75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. Results : Among the 252 eligible patients, 165 (median age 85 years [interquartile range (IQR) 81-90] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [9-13], 24 (14.5%) had a pulmonary HAI; 30 (18.2%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P=0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P=0.03, or psychiatric disease, P=0.02) and albumin level < 35 g/l (p=0.02). Significant association were found between functional decline and CIRS-G for respiratory diseases (CIRS-G-R) (OR 2.82 [95% CI 1.18-6.71], p=0.016), between functional decline and pulmonary HAI (OR 4.09 [1.48-11.34],p=4.09), and between CIRS-G-R and pulmonary HAI (OR 10.9 [5.26-22.5],p=0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 1.91 [0.71-5.16], p=0.20) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. Conclusion : Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.

show abstract

“…Although the causal relationship between coping and mood/anxiety has not yet been defined for patients with hip fracture, findings from this study show that a quarter of the patients use passive reacting strategies, which in turn may add to the risk of depression and anxiety. Prevalence rates for anxiety and depression are high among older adults with hip fracture (35.0% respectively 44.5%) (Gialanella et al, 2014) (Charles-Lozoya et al, 2019 (Feng et al, 2010), and these conditions are associated with a greater risk of poor outcomes of rehabilitation (Gialanella, Ferlucci, Monguzzi, & Prometti, 2015;Lenze et al, 2004;Proctor et al, 2008). Moreover, there is evidence to suggest that 10% of patients with hip fracture develop depressive symptoms after fracture, with a persistent high level of symptoms up to a year after fracture (Cristancho, Lenze, Avidan, & Rawson, 2016).…”

Section: Discussionmentioning

confidence: 99%

Coping strategies of older adults with a recent hip fracture within inpatient geriatric rehabilitation

Scheffers-Barnhoorn

Sharma-Virk

Balen

et al. 2021

Aging & Mental Health

View full text Add to dashboard Cite

Objectives: Coping strategies may play an important role as facilitator or barrier for functional recovery after hip fracture. This study explored 1] active and passive coping strategies in hip fracture patients within inpatient geriatric rehabilitation (GR) 2] the association of these coping strategies with depression, anxiety, pain and health-related quality of life (HRQoL) Method: Secondary data analysis (FIT-HIP trial). Participants were patients with hip fracture, aged 65þ years, admitted to post-acute GR units. Coping was assessed using the 'Active Tackling' and 'Passive Reacting' subscale of Utrecht Coping List (UCL). Depression, anxiety, pain and HRQoL was assessed using GDS-8, HADS-A, NPRS and EQ5D-VAS. Based on UCL norm tables-for both subscales-we dichotomized the group into (extremely) high use of this coping strategy i.e. 'predominantly active coping' (PAC), and 'predominantly passive coping' (PPC); versus their corresponding 'residual groups', i.e. the remaining participants. Results: 72 participants were included. Participants mostly used active coping (PAC: 33.3%), however those engaging in passive coping (23.6%) had significantly more depression and anxiety symptoms (GDS-8 ! 3: 31.1% respectively 9.1%, p ¼ 0.040; HADS-A ! 7: 58.8% vs 10.9%; p ¼ 0.00). Conclusion: Active tackling and passive reacting coping strategies are used by up to one-third of patients with recent hip fracture. Passive coping was associated with more symptoms of depression and anxiety, which in turn may influence rehabilitation negatively. Screening of (passive) coping strategies could contribute to prompt identification of hip fracture patients at risk for negative health outcomes.

show abstract

Determinants of functional outcome in hip fracture patients: the role of specific neuropsychiatric symptoms

Cited by 17 publications

References 37 publications

Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study

Functional decline in geriatric rehabilitation ward; is it ascribable to Hospital Acquired Infection? A prospective cohort study.

Coping strategies of older adults with a recent hip fracture within inpatient geriatric rehabilitation

Contact Info

Product

Resources

About