Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study

Itziar Vergara, Kalliopi Vrotsou, Miren Orive, Nerea Gonzalez, Susana Garcia, Jose M Quintana, Itziar Vergara, Kalliopi Vrotsou, Miren Orive, Nerea Gonzalez, Susana Garcia, Jose M Quintana

Abstract

Background: A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture.

Methods: A prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis.

Results: Six months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function.

Conclusion: In our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.

Figures

Figure 1
Figure 1
Flow chart of the recruitment and follow-up process.
Figure 2
Figure 2
Hip function and health related quality of life change over six months: Hip function and health related quality of life change over six months of follow up by sex and age group for patients whose functional status had and had not deteriorated.

References

    1. Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992;13:489–508. doi: 10.1146/annurev.pu.13.050192.002421.
    1. Salva A, Bolibar I, Pera G, Arias C. Incidence and consequences of falls among elderly people living in the community. Med Clin (Barc ) 2004;122:172–176.
    1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701–1707. doi: 10.1056/NEJM198812293192604.
    1. Varas-Fabra F, Castro ME, de Torres LA P, Fernandez Fernandez MJ, Ruiz MR, Enciso BI. Falls in the elderly in the community: prevalence, consequences, and associated factors. Aten Primaria. 2006;38:450–455. doi: 10.1157/13094802.
    1. Silva Gama ZA, Gomez CA, Sobral FM. Epidemiology of falls in the elderly in Spain: a systematic review, 2007. Rev Esp Salud Publica. 2008;82:43–55. doi: 10.1590/S1135-57272008000100004.
    1. Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990;19:136–141. doi: 10.1093/ageing/19.2.136.
    1. Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M. Fall-induced injuries and deaths among older adults. JAMA. 1999;281:1895–1899. doi: 10.1001/jama.281.20.1895.
    1. Arfken CL, Lach HW, Birge SJ, Miller JP. The prevalence and correlates of fear of falling in elderly persons living in the community. Am J Public Health. 1994;84:565–570. doi: 10.2105/AJPH.84.4.565.
    1. Johnell O, Kanis JA. An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int. 2004;15:897–902. doi: 10.1007/s00198-004-1627-0.
    1. Bertram M, Norman R, Kemp L, Vos T. Review of the long-term disability associated with hip fractures. Inj Prev. 2011;17:365–370. doi: 10.1136/ip.2010.029579.
    1. Flikweert ER, Izaks GJ, Reininga IH, Wendt KW, Stevens M. Evaluation of the effect of a comprehensive multidisciplinary care pathway for hip fractures: design of a controlled study. BMC Musculoskelet Disord. 2013;14:291. doi: 10.1186/1471-2474-14-291.
    1. Norton R, Butler M, Robinson E, Lee-Joe T, Campbell AJ. Declines in physical functioning attributable to hip fracture among older people: a follow-up study of case–control participants. Disabil Rehabil. 2000;22:345–351. doi: 10.1080/096382800296584.
    1. Takayama S, Iki M, Kusaka Y, Takagi H, Tamaki S. Factors that influence functional prognosis in elderly patients with hip fracture. Environ Health Prev Med. 2001;6:47–53. doi: 10.1007/BF02897309.
    1. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD. Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res. 1998;348:22–28.
    1. Kristensen MT. Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med. 2011;47:257–264.
    1. Soteriades ES, Evans JC, Larson MG, Chen MH, Chen L, Benjamin EJ, Levy D. Incidence and prognosis of syncope. N Engl J Med. 2002;347:878–885. doi: 10.1056/NEJMoa012407.
    1. van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psychiatry. 1999;66:480–484. doi: 10.1136/jnnp.66.4.480.
    1. Baztan JJ, Hornillos M, Gonzalez-Montalvo JI. Geriatric day hospital. Characteristics, performance, and effectiveness. Med Clin (Barc ) 1993;101:699–704.
    1. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9:179–186. doi: 10.1093/geront/9.3_Part_1.179.
    1. Vergara I, Bilbao A, Orive M, Garcia-Gutierrez S, Navarro G, Quintana JM. Validation of the Spanish version of the Lawton IADL Scale for its application in elderly people. Health Qual Life Outcomes. 2012;10:130. doi: 10.1186/1477-7525-10-130.
    1. Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW. Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988;15:1833–1840.
    1. Bilbao A, Quintana JM, Escobar A, Las HC, Orive M. Validation of a proposed WOMAC short form for patients with hip osteoarthritis. Health Qual Life Outcomes. 2011;9:75. doi: 10.1186/1477-7525-9-75.
    1. Macaulay W, Yoon RS. Fixed-bearing, medial unicondylar knee arthroplasty rapidly improves function and decreases pain: a prospective, single-surgeon outcomes study. J Knee Surg. 2008;21:279–284. doi: 10.1055/s-0030-1247832.
    1. Ware J, Jr, Kosinski M, Keller SD. A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care. 1996;34:220–233. doi: 10.1097/00005650-199603000-00003.
    1. Gandek B, Ware JE, Aaronson NK, Apolone G, Bjorner JB, Brazier JE, Bullinger M, Kaasa S, Leplege A, Prieto L, Sullivan M. Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. J Clin Epidemiol. 1998;51:1171–1178. doi: 10.1016/S0895-4356(98)00109-7.
    1. Alonso J, Prieto L, Anto JM. [The Spanish version of the SF-36 Health Survey (the SF-36 health questionnaire): an instrument for measuring clinical results] Med Clin (Barc ) 1995;104:771–776.
    1. Shah S, Vanclay F, Cooper B. Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol. 1989;42:703–709. doi: 10.1016/0895-4356(89)90065-6.
    1. Mossey JM, Mutran E, Knott K, Craik R. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health. 1989;79:279–286. doi: 10.2105/AJPH.79.3.279.
    1. Magaziner J, Fredman L, Hawkes W, Hebel JR, Zimmerman S, Orwig DL, Wehren L. Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. Am J Epidemiol. 2003;157:1023–1031. doi: 10.1093/aje/kwg081.
    1. Koval KJ, Skovron ML, Aharonoff GB, Meadows SE, Zuckerman JD. Ambulatory ability after hip fracture: a prospective study in geriatric patients. Clin Orthop. 1995;310:150–159.
    1. Haentjens P, Autier P, Barette M, Venken K, Vanderschueren D, Boonen S. Survival and functional outcome according to hip fracture type: a one-year prospective cohort study in elderly women with an intertrochanteric or femoral neck fracture. Bone. 2007;41:958–964. doi: 10.1016/j.bone.2007.08.026.
    1. Koval KJ, Aharonoff GB, Su ET, Zuckerman JD. Effect of acute inpatient rehabilitation on outcome after fracture of the femoral neck or intertrochanteric fracture. J Bone Joint Surg Am. 1998;80:357–364.
    1. Lacas A, Rockwood K. Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med. 2012;10:4. doi: 10.1186/1741-7015-10-4.
    1. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, Seeman T, Tracy R, Kop WJ, Burke G, McBurnie MA, Cardiovascular Health Study Collaborative Research Group Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–M156. doi: 10.1093/gerona/56.3.M146.
    1. Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35:1347–1355.
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