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

BMC Geriatrics

Research Article

Jose M Quintana¹  Miren Orive¹  Nerea Gonzalez¹  Susana Garcia¹  Kalliopi Vrotsou²  Itziar Vergara² 

[1] Galdakao-Usansolo Hospital Research Unit, Galdakao, Bizkaia, Spain;Health Services Research on Chronic Patients Network (REDISSEC), San Sebastian-Donostia, Spain;Primary Care Research Unit Gipuzkoa, Osakidetza, Paseo Dr Beguiristain s/n, 20014, San Sebastian-Donostia, Spain;Health Services Research on Chronic Patients Network (REDISSEC), San Sebastian-Donostia, Spain;Biodonostia Health Research Institute, San Sebastian-Donostia, Spain;

关键词: Hip fractures;    Elderly;    Cohort study;   

DOI  :  10.1186/1471-2318-14-124

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

来源: Springer

【 摘 要 】

BackgroundA 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.MethodsA 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.ResultsSix 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.ConclusionIn 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】

CC BY   
© Vergara et al.; licensee BioMed Central Ltd. 2014