The Effect of Social Isolation on 1-Year Outcomes After Surgical Repair of Low Energy Hip Fracture

Abstract

OBJECTIVES: To evaluate if social isolation or loneliness is associated with outcomes 1 year after low energy hip fracture. METHODS: Design: Prospective inception cohort study. Setting: Academic Level I Trauma Center. Patient Selection Criteria: Participants were ≥ 65 years of age and enrolled 2-4 days after surgery for a first low energy hip fracture. Exclusion criteria were bilateral or periprosthetic hip fracture, previous hip fracture, non-English speaking, international address, active cancer, stage 4 cancer in the past 5 years, radiation to the hip region and cognitive impairment. Participants were followed longitudinally for one year. Outcome Measures and Comparisons: The PROMIS-29 was elicited 2-4 days post-operatively and 1 year later. Patient reported risk factors included the Lubben Social Networks Scale and the UCLA Loneliness Scale, which were compared to the Lower Extremity Activity Scale and PROMIS-29 domains. RESULTS: Three hundred and twenty-five patients were enrolled. Participants had a median age of 81.7 years, were 70.9 % female and were 85.9% white. 31.6% of patients were socially isolated at time of fracture. At 1 year, 222 of the 291 subjects who were confirmed alive at one year provided data. Multivariable linear models were performed separately for each outcome, including Lower Extremity Activity Scale and PROMIS-29 domains. Controlling for age, sex, education, and body mass index, those who were socially isolated at time of fracture had worse PROMIS-29 function (β= -3.83 p= 0.02) and ability to participate in social roles (β= -4.17 p= 0.01) at 1 year. Secondary analyses found that pre-fracture loneliness was associated with clinically meaningfully worse function, anxiety, depression, fatigue, sleep, pain and ability to participate in social roles at 1 year, (all p< 0.01). CONCLUSIONS: Pre-fracture social isolation was associated with worse outcomes 1 year after surgical repair of low energy hip fracture. This data suggests loneliness may be more strongly associated with important patient centric metrics than pre-fracture social isolation. Given the dearth of modifiable risk factors in this population, future studies are needed to evaluate whether improving social connections could impact outcomes in this rapidly growing demographic.