Cognitive Improvement in Older Adults in the Year After Hip Fracture: Implications for Brain Resilience in Advanced Aging

Abstract

Objective: We examined cognitive function in nondemented, nondelirious older adults 1 year post hip fracture.

Design: Prospective observational study.

Setting and participants: Three hundred eighty-six hip fracture patients aged 60 years and older with no history of cognitive impairment, such as clinical dementia or persistent delirium, recruited from eight area hospitals 2-3 days after hip surgery (week 0), and 101 older adults with no recent acute medical events for control comparison.

Methods: Cognitive function was examined with the Repeatable Battery for the Assessment of Neuropsychological Status and the Short Blessed Test (SBT) at weeks 0 (SBT only), 4, and 52 using a repeated measures mixed model analysis. Baseline predictor variables included demographics, personality, genetic factors, and depressive symptom level.

Results: Hip fracture participants had lower cognitive scores than healthy comparisons. Cognitive scores improved in the hip fracture group relative to healthy comparison participants from week 4-52. The only significant predictor of cognitive improvement after hip fracture was education: individuals with college education showed cognitive improvement by week 52, while those with high school or less did not.

Conclusion: Nondemented, nondelirious older adults suffering hip fracture have poorer cognitive function immediately after the fracture but then exhibit cognitive improvement over the ensuing year, especially among those with high education. This demonstrates brain resilience in older adults even in the context of advanced age, medical illness, and frailty.

Keywords: Hip fracture; cognitive decline; delirium.

Copyright © 2018 Elsevier Ltd. All rights reserved.

Figures

Figure 1:

Changes in Cognitive Functioning in the Year following Hip Fracture, Stratified by Educational Attainment (>12 years versus ≤ 12 years). Individuals with higher educational level improved from week 4 to 52 after fracture, while those with high school or less did not. Cognitive functioning in healthy comparisons is shown as a reference condition. Vertical bars represent standard error.