Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study

Abstract

Background: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

Objectives: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.

Design: Observational study.

Participants: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

Main measures: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

Key results: A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

Conclusions: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

Keywords: activities of daily living; function; geriatrics; hip fracture; palliative care.

Conflict of interest statement

Compliance with Ethical Standards Funders Supported by the San Francisco Veterans Affairs Medical Center and Division of Geriatrics, University of California, San Francisco; VLT was supported in part by the National Institute on Aging (NIA at the National Institutes of Health (NIH) (5-T32-AG00212) and the Veterans Affairs (VA) Quality Scholars Fellowship Program; RS was supported in part by the VA investigator Initiated Research (11-110-2), NIA at the NIH (R01 AG045043), Patient-Centered Outcomes Research Institute (CDR-1306-01500), Robert Wood Johnson Foundation, American Cancer Society, John and Wauna Harman Foundation, and S.D. Bechtel, Jr. Foundation; AKS was supported in part by NIA at NIH grants (K23AG040772 and R01AG047897) and the American Federation for Aging Research; KC and CR were supported in part by National Institute of Nursing Research at the NIH (R01 NR013347); KC, CR, and EF were supported in part by NIA at NIH (P30AG04428); KC was supported by NIA at NIH (K24AG029812); EF was supported in part by NIA at NIH (R01 AG044425); MW was supported in part by the John A. Hartford Foundation. Prior Presentations We presented an earlier version of the manuscript as an oral abstract presentation in consideration for the Mack Lipkin Sr. Associate Member Scientific Presentation Award at the Society of General Internal Medicine National Meeting in Toronto, Canada, in 2015. Conflict of Interest All authors declare no conflicts of interest.

Figures

Fig. 1

Likelihood of returning to pre-hip fracture function in groups stratified by baseline function. This figure presents the proportion of HRS subjects with hip fracture returning to their prior ADL, mobility, and climbing function at the follow-up interview 6 months–2.5 years after the hip fracture (average, 12.5 ± 8.1 months), stratified by their baseline function. a Activities of daily living (ADL). b Walking. c Climbing. Footnote: Baseline function is determined by the pre-hip fracture interview most immediate to the hip fracture event. Returning to pre-hip fracture function was measured by comparing the function reported in the interview 6 months to 2.5 years after the hip fracture to their baseline function (mean 12.5 ± 8.1 months).