Predictors of Functional Recovery One Year Following Hospital Discharge for Hip Fracture: A Prospective Study

Abstract

This study evaluates predictors of recovery in walking ability, PADLs, and IADLs one year following hospital discharge for hip fracture. The sample consisted of 536 hip fracture patients aged 65 and older admitted from the community to one of seven Baltimore area hospitals between 1984 and 1986 and surviving one year post-hospital discharge. A large proportion of hip fracture patients do not regain pre-fracture PADL and IADL levels; most recovery in walking ability and ability to perform PADL and IADLs occurs by 6 months. Those who are older, have longer hospital stays, and are rehospitalized, exhibit poorer recovery, as do those displaying chronic or acute cognitive deficits and depressive symptomatology while hospitalized. Also, contact with one's social network following hospital discharge is associated with greater recovery. Findings point to the importance of psychosocial factors for recovery and suggest areas where hospital-based interventions and discharge planning efforts should focus.

Advances in osteoporosis: better identification of risk factors can reduce morbidity and mortality

“…Predictors of a poor recovery included advanced age, prolonged hospital stay, a subsequent hospitalization, and cognitive deficits or depression during hospitalization. Telephone contact with a social network after surgery was associated with recovery in all examined parameters [19]. In one British study, only 40% of patients who walked unaided or with a cane before the fracture returned to their previous level of walking ability.…”

“…The mortality rate for hip fracture patients ranges from 17 to 33% for the first year after discharge from the hospital [7,[15][16][17][18][19]. Most of the excess mortality occurs in the first few months after the fracture [18].…”

“…Indeed, pain and disability must be directly measured to understand the impact of an intervention on health-related quality of life [24]. Interventions to reduce falls and fracture complications beyond 6 months postoperatively may be beneficial for hip fracture patients [19].…”

Pre-operative pulmonary assessment for patients with hip fracture

“…The 1-year mortality after hip fracture is between 20% and 35% in the elderly [4, 5]. Among those who survived at 1 year, only half of them were able to perform activities of daily living [6]. Hip fracture surgery, including hip pinning and hemiarthroplasty, is the mainstay treatment.…”

The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

“…6 One year after surviving a hip fracture, approximately 50% of patients have a walking disability, 7 and only 40% independently perform all activities of daily living. 8 Predicting the risk of hip fracture in the primary care setting is vital, both for physicians to make appropriate recommendations and for patients to make informed decisions about management.…”