Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

Abstract

OBJECTIVES To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN Retrospective cohort study. SETTING Academic hospital with ambulatory follow‐up. PARTICIPANTS Community‐dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS Baseline, 3‐ and 6‐month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in‐hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in‐hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in‐hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in‐hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION Age, dementia, in‐hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

Predictive Model of Gait Recovery at One Month after Hip Fracture from a National Cohort of 25,607 Patients: The Hip Fracture Prognosis (HF-Prognosis) Tool

“…We have identified several predictors of recovering ambulation after hip fracture, consistent with most studies. Age is one of the most cited factors, with older patients taking longer to regain their baseline walking ability or at greater risk of not achieving it [ 23 , 24 , 25 , 26 , 27 , 28 ]. Gender did not significantly affect ambulatory recovery in our study, nor in previous ones [ 29 , 30 , 31 ].…”

Factores que afectan la recuperación funcional del adulto mayor independiente con fractura de cadera

“…Fuente: Elaboración propia basada en las referencias 7,[9][10][11][12][13][15][16][17][18]20,[22][23][24][25][26]29,30 .…”

Prognostic performance of clinical assessment tools following hip fracture in patients with chronic kidney disease

“…Increased morbidity and mortality following hip fracture is compounded by factors such as frailty [ 6 ], sarcopenia [ 7 ] and CKD-associated mineral and bone disorder (CKD-MBD) [ 8 ]. A significant decline in functional status following acute trauma is frequently observed for patients with various co-morbidities including CKD [ 9 ]. Due to this marked decline, rehabilitation following hip fracture is more difficult for patients with CKD compared to the general population [ 9 ].…”

“…A significant decline in functional status following acute trauma is frequently observed for patients with various co-morbidities including CKD [ 9 ]. Due to this marked decline, rehabilitation following hip fracture is more difficult for patients with CKD compared to the general population [ 9 ]. Importantly, mortality outcomes are worse for patients with reduced functional status [ 10 ].…”