Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study

Abstract

BackgroundA restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture.MethodsA prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis.ResultsSix months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function.ConclusionIn our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.

Impact of Osteoarthritis on Difficulty Walking: A Population‐Based Study

“…Our results confirmed a significant and independent effect of CV diseases, hypertension, diabetes mellitus, hip fracture, malignancy, mental illness, and neurologic disorders on walking difficulty (21,23,(39)(40)(41)(42)(43)(44). However, the effects of these conditions were relatively small after controlling for OA, BMI, and PVD.…”

A Critical Review of the Long-Term Disability Outcomes Following Hip Fracture

“…Up to 70 % of people may regain their pre-fracture level of independence for composite measures of basic ADL [22,48,51], but this proportion is likely to be lower for those with higher levels of dependence pre-fracture [48]. Half or fewer people experiencing hip fracture may regain their [14,38,47]. For those highly independent pre-fracture, more than 70 % may recover their self-care independence for particular ADL activities (eg.…”

“…The majority of studies included patients aged 60 or 65 years and over, although nine studies included patients aged 50 years or over [12,18,24,25,[30][31][32][33][34][35][36]. Eight studies specifically enrolled patients with hip fracture as a result of low-impact trauma or falls [12,23,27,33,[36][37][38][39]; one included patients with fractures obtained from low to moderate energy trauma [30]. The remaining studies did not use the type of trauma that the injury was sustained from as an eligibility criterion.…”

Hüftendoprothetik nach Trauma

“…Etwa ein Drittel der geriatrischen Patienten verstirbt innerhalb des ersten Jahres [3,21], ein weiteres Drittel wird neu institutionalisiert [13], und 5-9 % der Patienten behalten bleibende funktionelle Einschränkungen zurück [26,38]. Das Risiko, innerhalb eines Jahres eine weitere osteoporosebedingte Fraktur zu erleiden, beträgt ca.…”