Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

Schaller, F.; Sidelnikov, Eduard; Egli, Andreas; Staehelin, Hannes B.; Dick, W.; Dawson‐Hughes, Bess; Grob, Daniel; Platz, Andreas; Can, Uenal; Bischoff‐Ferrari, Heike A.

doi:10.1016/j.bone.2012.06.004

Cited by 67 publications

(49 citation statements)

References 41 publications

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“…Previous studies have investigated the predictive role of preoperative cognitive impairment (24–28), postoperative delirium (29) or both (30–33) relative to hip fracture surgery, but definitions of dementia in particular have varied widely across studies making direct comparisons between studies difficult. In general, studies find dementia, independent of severity, as predictive of mortality in this population (14), but those that stratify based on severity reveal a step-wise effect—those with more severe dementia have higher mortality rates (24, 30).…”

Section: Discussionmentioning

confidence: 99%

Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification

Lee

Oldham

Sieber

et al. 2017

The American Journal of Geriatric Psychiatry

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Objectives: We evaluated whether delirium after hip fracture repair modifies the relationship between baseline dementia and one-year mortality after surgery. Methods: Patients age ≥ 65 undergoing hip fracture repair surgery at John Hopkins Bayview Medical Center between 1999 and 2009 were eligible for this prospective cohort study. Baseline probable dementia was defined as either preoperatively-diagnosed dementia per geriatrician or < 24 on Mini Mental State Examination. Delirium was assessed using the Confusion Assessment Method. Four cognitive groups were defined: 1) neither probable dementia nor delirium (NDD), 2) probable dementia only, 3) delirium only, or 4) delirium superimposed on dementia (DSD). Primary outcome of mortality was obtained through hospital records, obituaries, the National Death Index, and Social Security Death Index. Results: The current sample comprises 466 subjects (average age 80.8 ± 7.0 years; 73.6% female). Of these, 77 (17%) were categorized as DSD, 68 (15%) probable dementia only, 73 (16%) delirium only, and 248 (53%) NDD. Cox regression revealed that DSD subjects had a significantly higher hazard of one-year mortality than NDD subjects (HR 1.71, 95% CI 1.06, 2.77) after adjusting for age, sex, medical comorbidity, and surgery duration. Trends toward greater mortality for probable-dementia and delirium only subjects were not significant—HR 1.42 (0.80, 2.52) and 1.12 (0.64, 1.95). Conclusions: Delirium after hip fracture repair surgery in patients with preoperative dementia modifies the risk of mortality over the first postoperative year. Patients with DSD have a nearly two-fold greater odds of one-year mortality than those without dementia or delirium.

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Section: Discussionmentioning

confidence: 99%

Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification

Lee

Oldham

Sieber

et al. 2017

The American Journal of Geriatric Psychiatry

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“…However, a diagnosis of dementia was not necessary for this to occur, since mild to moderate cognitive impairment was also correlated with increased mortality, along with male gender and vitamin D deficiency. 65 Few clinical trials have explored ways to increase survival among hip fracture patients with cognitive impairment. A sub-analysis of the Horizon study has demonstrated an increase in survival after 12 months in hip fracture patients without cognitive impairment treated with zoledronic acid.…”

Section: Evaluations Of Orthogeriatric Unitsmentioning

confidence: 99%

“…17 Apart from the problems inherent to cognitive impairment and its associated health and social care costs, it is also implicated in the aetiology of bone fractures in older patients, 18 with the risk of low-impact falls and of subsequent injuries in such patients increasing 5-and 2.2-fold, respectively, compared with individuals without cognitive impairment. 19 The standard of hospital care of geriatric patients with hip fracture has been described as an independent risk factor for poorer functional outcomes, 20 increased immobilization and prolonged or permanent confinement to bed, an increased risk of being unable to walk again with or without help, 21 an increased risk of institutionalization, 22 and greater mortality both in hospital and in the 12 months after discharge. 9,23,24 Cognitive impairment is characterized by different degrees of severity, which in turn are correlated to the vital and functional prognosis.…”

Section: Introductionmentioning

confidence: 99%

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Tarazona-Santabalbina

Doménech-Pascual

et al. 2014

Rev. Clin. Gerontol.

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2014). The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care. SummaryHip fracture is very common among older patients, who are characterized by increased co-morbidities, including cognitive impairment. These patients have an increased risk of falls and fractures, poorer functional recovery and lower survival both in hospital and 12 months after discharge. We review the survival and functional outcomes of older patients with cognitive impairment and hip fracture managed in orthogeriatric units, and highlight the gaps in our knowledge of the efficacy and efficiency of specific orthogeriatric programmes for such patients and the future research perspectives in this field.

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“…It is scarcely surprising that differing severity levels of dementia are observed in 22-54% of patients with hip fractures [12,13,14,15,16]. It must be assumed that patients with hip fracture and preexisting cognitive impairment are at an even higher risk for poor postoperative outcomes compared with mentally healthy patients because of their preexisting mental and physical impairments.…”

Section: Introductionmentioning

confidence: 99%

Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

Bliemel

Lechler

Oberkircher

et al. 2015

Dement Geriatr Cogn Disord

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Objective: To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment. Methods: A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors. Results: 33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001). Conclusions: Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.

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Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

Cited by 67 publications

References 41 publications

Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification

Impact of Delirium After Hip Fracture Surgery on One-Year Mortality in Patients With or Without Dementia: A Case of Effect Modification

The approach to patients with cognitive impairment and hip fracture: the role of orthogeriatric care

Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures

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