Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study

Abstract

ObjectivesThe aims of this study were to examine the pattern of changes over time in health status (HS) and quality of life (QoL) in the first year after hip fracture and to quantify the association between frailty at the onset of hip fracture and the change in HS and QoL 1 year later. The major hypothesis was that frailty, a clinical state of increased vulnerability, is a good predictor of QoL in patients recovering from hip fracture.DesignProspective, observational, follow-up cohort study.SettingSecondary care. Ten participating centres in Brabant, the Netherlands.Participants1091 patients entered the study and 696 patients completed the study. Patients with a hip fracture aged 65 years and older or proxy respondents for patients with cognitive impairment were included in this study.Main outcome measuresThe primary outcomes were HS (EuroQol-5 Dimensions questionnaire) and capability well-being (ICEpop CAPability measure for Older people). Prefracture frailty was defined with the Groningen Frailty Indicator (GFI), with GFI ≥4 indicating frailty. Participants were followed up at 1 month, 3 months, 6 months and 1 year after hospital admission.ResultsIn total, 371 patients (53.3%) were considered frail. Frailty was negatively associated with HS (β −0.333; 95% CI −0.366 to −0.299), self-rated health (β −21.9; 95% CI −24.2 to −19.6) and capability well-being (β −0.296; 95% CI −0.322 to −0.270) in elderly patients 1 year after hip fracture. After adjusting for confounders, including death, prefracture HS, age, prefracture residential status, prefracture mobility, American Society of Anesthesiologists grading and dementia, associations were weakened but remained significant.ConclusionsWe revealed that frailty is negatively associated with QoL 1 year after hip fracture, even after adjusting for confounders. This finding suggests that early identification of prefracture frailty in patients with a hip fracture is important for prognostic counselling, care planning and the tailoring of treatment.Trial registration numberNCT02508675

Preoperative anemia and total hospitalization time are the independent factors of preoperative deep venous thromboembolism in Chinese elderly undergoing hip surgery

“…Inoue et al [26] also pointed that the frailty can be assessed as a predict short-term functional recovery during the acute phase in patients with hip fracture. Therefore, early identification of prefracture frailty in patients with a hip fracture is important for prognostic counselling, care planning and the tailoring of treatment [27].…”

Frailty in the perioperative setting

“…In those undergoing elective orthopaedic surgery, 23% were frail in comparison to emergency hip fracture surgery where 53% of patients were defined as frail. 13,14 Considering cancer surgery, studies report a prevalence of 25% of patients undergoing elective cystectomy as being frail with a similarly high prevalence of frailty in emergency general surgical patients of 39% where the underlying pathology is often neoplastic. 15,16 In vascular surgery, aortic aneurysms and peripheral arterial disease increase with age, with an estimated 52% of elective vascular patients being frail.…”

Frailty assessment, hip fracture and long‐term clinical outcomes in older adults

“…However, routine perioperative hip fracture care is often marked by invasive procedures, bed rest, delirium, and pain that hamper objective and thorough frailty assessments 16‐18 . Implementing an immediate, more accessible and time‐saving instrument of frailty screening, based on rigorous methodologic standards, would likely facilitate its diagnosis, guiding appropriate prognostic and management strategies in frail older adults after hip fracture 19 …”