Trajectories in postoperative recovery of elderly hip-fracture patients at risk for depression: A follow-up study.

Abstract

Depressive symptoms in elderly hip-fracture patients may be alleviated by postoperative comprehensive care that features both psychological and physical interventions. Patients with increasing depressive status should be targeted for early interventions. (PsycINFO Database Record

Prognostic factors of depression and depressive symptoms after hip fracture surgery: systematic review

“…Depression or depressive symptoms were measured using the Depression Anxiety Stress Scale in one study [ 28 ], the Montgomery- Åsberg Depression Rating Scale in three studies [ 15 , 30 , 35 ], Structured Clinical Interview for DSM-IV disorders (SCID-IV) in two studies [ 15 , 32 ], the Geriatric Depression Scale – Short Form (GDS-SF) in one study [ 29 ], the Geriatric Depression Scale in three studies [ 31 , 34 , 35 ], the Geriatric Depression Scale-Chinese version in two studies [ 10 , 33 ], the Hamilton Depression Rating Scale (Ham-D) in two studies [ 13 , 32 ], Primary Care Evaluation of Mental Disorders in one study [ 13 ] and the Hospital Anxiety and Depression Scale (HADS) in two studies [ 14 , 35 ]. Baseline timepoints (where reported) ranged from on admission [ 29 ] to prior to discharge [ 10 , 13 , 32 , 33 ] or 22 days post-hip fracture [ 34 ]. Follow up time points ranged from 1-week post-surgery [ 30 ] to 12 months after hip fracture/surgery [ 10 , 14 , 30 , 31 , 33 , 34 ].…”

“…Baseline timepoints (where reported) ranged from on admission [ 29 ] to prior to discharge [ 10 , 13 , 32 , 33 ] or 22 days post-hip fracture [ 34 ]. Follow up time points ranged from 1-week post-surgery [ 30 ] to 12 months after hip fracture/surgery [ 10 , 14 , 30 , 31 , 33 , 34 ].…”

“… Lenze, 2007, USA [ 13 ] 126 Major Depressive Disorder group: 78.3 years 16.7% male 100% Caucasian No Major Depressive Disorder group: 81.8 years 20.4% male 91.7% Caucasian 61% MDD cases had onset of MDD symptoms before discharge from the acute care hospital, whereas the other seven had onset of symptoms between 2 and 10 weeks after the hospitalization Demographic variables and characteristics of the fracture, Functional status, Delirium, cognition, social support, medical comorbidity, Apathy, memory, executive function, Surgery LOS, characteristics of the surgery Hamilton Depression Rating Scale (Ham-D), Primary Care Evaluation of Mental Disorders 2002–2004 Baseline = End of hospital stay. Followed up after 2 weeks, then every 4 weeks until 26 weeks post hospital discharge Functional status measured prefracture through interview during hospital stay Lenze, 2008, USA [ 31 ] 145 81.2 years 95.9% Caucasian woman Pre-fracture function, comorbidities, ADLs, genetic samples-molecular weight DNA, 5HTR1A and 5HTR2AA Geriatric Depression Scale 1998–2004 Baseline = 12 days post-fracture Followed up at 2, 6, and 12-months post-fracture Lenze, 2005, USA [ 32 ] 23 s Allele group: 78.8 years 77% female 100% white l/l Genotype group: 76.2 years 100% female 90% white Genotype −5-HTTLPR Hamilton Rating Scale for Depression, mood module of the Structured Clinical Interview for DSM-IV Axis I Disorders 2002–2003 Baseline = end of their hospital stay Followed up at 2, 6, 10 and 14 weeks after hospital discharge Liu 2018, Taiwan [ 33 ] 179 76.7 years 68.2% female Average number of comorbidities was 2.45 Age, gender, marital status, educational level, comorbidities, cognitive impairment, functional impairment, care model and group membership probability, prefracture mobility Geriatric Depression Scale-Chinese version 2005–2010 Baseline = before discharge Followed up at 1, 3, 6, and 12-months post- discharge Matheny, 2011, USA [ 34 ] 134 81.7 years 96.3% Caucasian All participants were female Age, height, weight, comorbidities, cognitive status, inflammatory cytokines, lower extremity function Geriatric Depression Scale (GDS) 1998–2004 Baseline-within 22 days post-hip fracture Followed up at 2, 6 and 12-months post fracture …”

“…Three out of the 12 studies were at moderate risk of bias for study participation [ 28 – 30 ], while the other nine studies were at low risk of bias [ 10 , 13 – 15 , 31 – 35 ]. Five studies were at high risk of bias for study attrition [ 15 , 28 – 30 , 34 ], four studies were judged to be at moderate risk [ 14 , 31 , 33 , 35 ], and the others deemed to be at low risk of bias [ 10 , 13 , 32 ]. One study [ 29 ] was judged to be at high risk of bias for prognostic factor measurement, six out of the 12 studies were at moderate risk of bias [ 10 , 15 , 28 , 33 – 35 ], and the remaining five studies were at low risk [ 13 , 14 , 30 – 32 ].…”

Rehabilitation Following Hip Fracture

“…Psychosocial factors are predictors of hip fracture recovery and their role in functional recovery after hip fracture has been acknowledged as important [92]. Depressive symptoms post hip fracture increase the likelihood of poorer mobility, function and psychological outcomes [92][93][94]. Fear of falling is common in people with hip fracture and is associated with poorer recovery, decreased mobility, anxiety and falls-related selfefficacy [95][96][97].…”