Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study

Cornelis L P van de Ree, Maud J F Landers, Nena Kruithof, Leonie de Munter, Joris P J Slaets, Taco Gosens, Mariska A C de Jongh, Cornelis L P van de Ree, Maud J F Landers, Nena Kruithof, Leonie de Munter, Joris P J Slaets, Taco Gosens, Mariska A C de Jongh

Abstract

Objectives: The aims of this study were to examine the pattern of changes over time in health status (HS) and quality of life (QoL) in the first year after hip fracture and to quantify the association between frailty at the onset of hip fracture and the change in HS and QoL 1 year later. The major hypothesis was that frailty, a clinical state of increased vulnerability, is a good predictor of QoL in patients recovering from hip fracture.

Design: Prospective, observational, follow-up cohort study.

Setting: Secondary care. Ten participating centres in Brabant, the Netherlands.

Participants: 1091 patients entered the study and 696 patients completed the study. Patients with a hip fracture aged 65 years and older or proxy respondents for patients with cognitive impairment were included in this study.

Main outcome measures: The primary outcomes were HS (EuroQol-5 Dimensions questionnaire) and capability well-being (ICEpop CAPability measure for Older people). Prefracture frailty was defined with the Groningen Frailty Indicator (GFI), with GFI ≥4 indicating frailty. Participants were followed up at 1 month, 3 months, 6 months and 1 year after hospital admission.

Results: In total, 371 patients (53.3%) were considered frail. Frailty was negatively associated with HS (β -0.333; 95% CI -0.366 to -0.299), self-rated health (β -21.9; 95% CI -24.2 to -19.6) and capability well-being (β -0.296; 95% CI -0.322 to -0.270) in elderly patients 1 year after hip fracture. After adjusting for confounders, including death, prefracture HS, age, prefracture residential status, prefracture mobility, American Society of Anesthesiologists grading and dementia, associations were weakened but remained significant.

Conclusions: We revealed that frailty is negatively associated with QoL 1 year after hip fracture, even after adjusting for confounders. This finding suggests that early identification of prefracture frailty in patients with a hip fracture is important for prognostic counselling, care planning and the tailoring of treatment.

Trial registration number: NCT02508675.

Keywords: elderly; frailty; hip fracture; quality of life.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of study participants. Participants who missed some of the measurements are indicated as ‘no show’. GFI, Groningen Frailty Indicator; T1, 1 week; T2, 1 month; T3, 3 months; T4, 6 months; T5, 1 year.
Figure 2
Figure 2
Patterns of health status according to frailty status over time. EQ-5D, EuroQol-5 Dimensions.
Figure 3
Figure 3
Percentage of frail (A) and non-frail (B) patients reporting problems on each EuroQol-5 Dimensions 3 Level. Questionnaire item at each follow-up time point.
Figure 4
Figure 4
Patterns of capability well-being according to frailty status over time. ICECAP-O, ICEpop CAPability measure for Older people.

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