Prognostic factors for 1-year functional outcome, quality of life, care demands, and mortality after surgery in Taiwanese geriatric patients with a hip fracture: a prospective cohort study

Abstract

Background: Hip fractures are a major public health concern among elderly individuals. This study aimed to investigate potential perioperative factors that predict 1-year functional outcome, quality of life (QoL), care demands, and mortality in geriatric patients with a hip fracture. Methods: We prospectively enrolled geriatric patients who had undergone hip fracture surgery in one medical center from December 2017 to December 2019. Basic demographic data, handgrip strength, and responses to questionnaires for QoL and activities of daily living (ADL) before the injury were collected at baseline. QoL, ADL, additional care demands other than family support, and mortality events were monitored at 1 year after the operation. Results: Among 281 patients with a hip fracture, 39 (13.9%) died within 1 year of the index operation. The mean follow-up interval for the survivors was 403.3 (range: 358–480) days. Among the 242 survivors, ADL and QoL considerably decreased at approximately 1 year following hip surgery. Up to 33.9% of the participants became severely dependent and needed additional care at 1-year follow up. Prefracture ADL status was the crucial predictor for functional outcome, QoL, and additional care demand at 1-year follow up. Cox regression models indicated that male sex, low preoperative serum creatinine, handgrip strength, long surgical delay after a falling accident, and high Charlson Comorbidity Index were considerably associated with a high 1-year mortality risk in the geriatric hip fracture population. Conclusion: Hip fracture has long-lasting effects (e.g. functional loss, decline in QoL, increased care demands, and high postoperative mortality rate) on the geriatric population. A robust screening method must be developed for identifying potential prognostic factors, and a stratified care approach must be used that accounts for personalized risks to improve functional outcomes and reduce mortality after hip fracture in geriatric patients, especially in Taiwan.

Inverse relation of body weight with short-term and long-term mortality following hip fracture surgery: a meta-analysis

“…The reported in-hospital mortality rate for older patients receiving hip fracture surgery was estimated to be approximately 2% [ 2 ], and the 1-year mortality rate following hip fracture surgery ranges from 14 to 18.1% [ 3 ]. In addition, one-third of the older population is reportedly severely dependent at 1 year after hip fracture surgery [ 4 ]. Moreover, the incidence of hip fracture appears to be increasing especially in developing populations in Asia [ 5 ].…”

Improving the care stress, life quality, and family functions for family-caregiver in long-term care by home modification

“…Family caregivers often bear considerable stress as a result of their caring duties. For example, older adults with severe disabilities (or poor physical resilience) are mostly unable to walk or move independently and require caregivers to move them around in a wheelchair 8 , 9 ) . The caregiver must overcome environment-induced obstacles to mobility—for example, uneven paths, insufficient width of the exit or entrance, or insufficient space for turning—by lifting the wheelchair or moving the care receiver, which increases the caregiver’s burden of care.…”

Multipronged Programmatic Strategy for Preventing Secondary Fracture and Facilitating Functional Recovery in Older Patients after Hip Fractures: Our Experience in Taipei Municipal Wanfang Hospital

“…Regarding refracture risk, good compliance to osteoporosis treatment is necessary for fracture risk reduction, with increasing benefit observed with higher compliance [ 24 ]. However, because the older adult patients after hip fractures are at a great risk of losing some degree of motility after surgery [ 8 , 25 ], return to clinics for regular AOM treatment may be a difficult task, which may result in poor compliance to AOM treatment after hip fracture surgery. A multicenter study in a high-level intervention FLS reported that the first-year persistence rates for AOM use was only 66.4% after the initiation of osteoporosis treatment [ 26 ].…”

“…The 1-year mortality rate associated with a geriatric hip fracture ranges from 14.0% to 18.1% [ 4 , 5 , 6 ], but it can be as high as 36% 1 year after surgery [ 7 ]. In our previous study, up to 33.9% of the 281 older adult patients with hip fractures exhibited severe dependence and required additional care at the 1-year follow-up [ 8 ]. Moreover, patients with hip fractures were five times more likely to experience a hip refracture within 1 year [ 9 ].…”