Association between Caregiver Role and Short- and Long-Term Functional Recovery after Hip Fracture: A Prospective Study

A 2-min cognitive screener for predicting 1-year functional recovery and survival in older adults after hip fracture repair

BACKGROUND

Implementing cognitive assessment in older people admitted to hospital with hip fracture - lying in bed, experiencing pain - is challenging. We investigated the value of a quick and easy-to-administer 10-point cognitive screener (10-CS) in predicting 1-year functional recovery and survival after hip surgery.

METHODS

Prospective cohort study comprising 304 older patients (mean age=80.3±9.1 years; women=72%) with hip fracture consecutively admitted to a specialized academic medical center that supports secondary hospitals in Sao Paulo Metropolitan Area, Brazil. The 10-CS, a 2-minute bedside tool including temporal orientation, verbal fluency, and three-word recall, classified patients as having normal cognition, possible cognitive impairment, or probable cognitive impairment on admission. Outcomes were time-to-recovery activities of daily living (ADLs; Katz index) and mobility (New Mobility Score), and survival during 1-year after hip surgery. Hazard models, considering death as a competing risk, were used to associate the 10-CS categories with outcomes after adjusting for sociodemographic and clinical measures.

RESULTS

On admission, 144 (47%) patients had probable cognitive impairment. Compared to those cognitively normal, patients with probable cognitive impairment presented less postsurgical recovery of ADLs (77% vs. 40%; adjusted sub-hazard ratio [HR]=0.44; 95%CI=0.32-0.62) and mobility (50% vs. 30%; adjusted sub-HR=0.52; 95%CI=0.34-0.79), and higher risk of death (15% vs. 40%; adjusted HR=2.08; 95%CI=1.03-4.20) over 1-year follow-up.

CONCLUSIONS

The 10-CS is a strong predictor of functional recovery and survival after hip fracture repair. Cognitive assessment using quick and easy-to-administer screening tools like 10-CS can help clinicians make better decisions and offer tailored care for older patients admitted with hip fracture.

Timeline of functional recovery after hip fracture in seniors aged 65 and older: a prospective observational analysis

We investigated the timeline of functional recovery after hip fracture over 12 months in adults age ≥ 65 years using objective lower extremity function tests and subjective physical functioning. Objective functional recovery was largely complete in the first 6 months, whereas subjective recovery improved up to 9 months after hip fracture.

INTRODUCTION

Hip fractures are a major cause of loss of function among seniors. We assessed the timeline of objective and subjective functional recovery after hip fracture.

METHODS

We conducted a prospective observational secondary analysis of a 1-year clinical trial on vitamin D and home exercise treatment and complications after hip fracture among 173 patients age ≥ 65 years (mean age 84 years; 79.2% women; 77.4% community-dwelling) conducted from January 2005 through December 2007. Lower extremity function (Timed Up and Go test (TUG), knee extensor and flexor strength) and grip strength was assessed at baseline and at 6 and 12 months follow-up. Subjective physical functioning was assessed using the SF-36 questionnaire also at 3 and 9 months follow-up. Multivariable-adjusted repeated-measures models were used to assess the timeline of functional recovery in the total population and in subgroups of patients.

RESULTS

Lower extremity function including TUG (- 61.1%), knee extensor (+ 17.6%), and knee flexor (+ 11.6%) strength improved significantly in the first 6 months (P < 0.001). However, between 6 and 12 months, there was no further significant improvement for any of the functional tests. Grip strength decreased from baseline to 6 months (- 7.9%; P < 0.001) and from 6 to 12 months (- 10.8%; P < 0.001). Subjective physical functioning improved from 3 to 9 months (+ 15.2%, P < 0.001), but no longer thereafter.

CONCLUSIONS

Functional recovery after hip fracture may be largely complete in the first 6 months for objective functional tests, whereas may extend up to 9 months for subjective recovery, with oldest-old, female, institutionalized, and cognitively impaired patients recovering most poorly.

CLINICAL TRIALS REGISTRY (ORIGINAL TRIAL)

NCT00133640.