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

BMC Geriatrics

Jose M Quintana²  Susana Garcia²  Nerea Gonzalez²  Miren Orive²  Kalliopi Vrotsou¹  Itziar Vergara¹ 

[1] Biodonostia Health Research Institute, San Sebastian-Donostia, Spain;Health Services Research on Chronic Patients Network (REDISSEC), San Sebastian-Donostia, Spain

关键词: Cohort study;    Elderly;    Hip fractures;   

Others  :  1089839
DOI  :  10.1186/1471-2318-14-124

 received in 2014-07-21, accepted in 2014-11-13,  发布年份 2014

【 摘 要 】

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.

【 授权许可】

   
2014 Vergara et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Sattin RW: Falls among older persons: a public health perspective. Annu Rev Public Health 1992, 13:489-508.
• [2]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.
• [3]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.
• [4]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.
• [5]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.
• [6]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.
• [7]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.
• [8]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.
• [9]Johnell O, Kanis JA: An estimate of the worldwide prevalence, mortality and disability associated with hip fracture. Osteoporos Int 2004, 15:897-902.
• [10]Bertram M, Norman R, Kemp L, Vos T: Review of the long-term disability associated with hip fractures. Inj Prev 2011, 17:365-370.
• [11]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. BioMed Central Full Text
• [12]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.
• [13]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.
• [14]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.
• [15]Kristensen MT: Factors affecting functional prognosis of patients with hip fracture. Eur J Phys Rehabil Med 2011, 47:257-264.
• [16]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.
• [17]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.
• [18]Baztan JJ, Hornillos M, Gonzalez-Montalvo JI: Geriatric day hospital. Characteristics, performance, and effectiveness. Med Clin (Barc ) 1993, 101:699-704.
• [19]Lawton MP, Brody EM: Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969, 9:179-186.
• [20]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. BioMed Central Full Text
• [21]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.
• [22]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. BioMed Central Full Text
• [23]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.
• [24]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.
• [25]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.
• [26]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.
• [27]Shah S, Vanclay F, Cooper B: Improving the sensitivity of the Barthel Index for stroke rehabilitation. J Clin Epidemiol 1989, 42:703-709.
• [28]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.
• [29]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.
• [30]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.
• [31]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.
• [32]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.
• [33]Lacas A, Rockwood K: Frailty in primary care: a review of its conceptualization and implications for practice. BMC Med 2012, 10:4. BioMed Central Full Text
• [34]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.
• [35]Cummings SM, Savitz LA, Konrad TR: Reported response rates to mailed physician questionnaires. Health Serv Res 2001, 35:1347-1355.