Predictors of Posttraumatic Stress Symptoms and Association with Fear of Falling After Hip Fracture

Hip fracture has profound psychosocial impacts: a systematic review of qualitative studies

BACKGROUND

Hip fracture is a common and serious traumatic injury for older adults characterised by poor outcomes.

OBJECTIVE

This systematic review aimed to synthesise qualitative evidence about the psychosocial impact of hip fracture on the people who sustain these injuries.

METHODS

Five databases were searched for qualitative studies reporting on the psychosocial impact of hip fracture, supplemented by reference list checking and citation tracking. Data were synthesised inductively and confidence in findings reported using the Confidence in the Evidence from Reviews of Qualitative research approach, taking account of methodological quality, coherence, relevance and adequacy.

RESULTS

Fifty-seven studies were included. Data were collected during the peri-operative period to >12 months post fracture from 919 participants with hip fracture (median age > 70 years in all but 3 studies), 130 carers and 297 clinicians. Hip fracture is a life altering event characterised by a sense of loss, prolonged negative emotions and fear of the future, exacerbated by negative attitudes of family, friends and clinicians. For some people after hip fracture there is, with time, acceptance of a new reality of not being able to do all the things they used to do. There was moderate to high confidence in these findings.

CONCLUSIONS

Hip fracture is a life altering event. Many people experience profound and prolonged psychosocial distress following a hip fracture, within a context of negative societal attitudes. Assessment and management of psychosocial distress during rehabilitation may improve outcomes for people after hip fracture.

The global prevalence of and risk factors for fear of falling among older adults: a systematic review and meta-analysis

BACKGROUND

As a common psychological problem among older adults, fear of falling was found to have a wide range prevalence in different studies. However, the global prevalence of it was unknown and a lack of the large sample confirmed its risk factors.

OBJECTIVES

To report the global prevalence of fear of falling and to explore its risk factors among older adults for further developing precise interventions to systematically manage FOF.

DESIGN

A systematic review and meta-analysis was conducted by PRISMA guidelines.

METHODS

Searches were conducted in PubMed, Web of Science, EMBASE, the Cochrane Library and the manual search in August 20, 2022, updated to September 2, 2023. Observational studies published in English were included and two researchers independently screened and extracted the data. Fixed or random effects mode was used to estimate the pooled prevalence of and risk factors for fear of falling. Heterogeneity resources were analyzed by subgroup and sensitivity analysis. Publication bias was assessed through funnel plots, Egger's test and Begg's test.

RESULTS

A total of the 153 studies with 200,033 participants from 38 countries worldwide were identified. The global prevalence of fear of falling was 49.60%, ranging from 6.96-90.34%. Subgroup analysis found the estimates pooled prevalence of it was higher in developing countries (53.40%) than in developed countries (46.7%), and higher in patients (52.20%) than in community residents (48.40%). In addition, twenty-eight risk factors were found a significant associations with fear of falling, mainly including demographic characteristics, physical function, chronic diseases and mental problems.

CONCLUSION

The global prevalence of FOF was high, especially in developing countries and in patients. Demographic characteristics, Physical function, chronic diseases and mental problems were a significant association with FOF. Policy-makers, health care providers and government officials should comprehensively evaluate these risk factors and formulate precise intervention measures to reduce FOF.

TRIAL REGISTRATION

The study was registered in the International Database of Prospectively Registered Systematic Reviews (PROSPERO): CRD42022358031.

Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study

BACKGROUND

Elderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF.

METHODS

A retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis.

RESULTS

We eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection.

CONCLUSION

Enhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.

A systematic review of fear of falling and related constructs after hip fracture: prevalence, measurement, associations with physical function, and interventions

BACKGROUND

Hip fracture is a common and debilitating injury amongst older adults. Fear of falling (FoF) and related constructs (balance confidence and falls efficacy) may impede rehabilitation after hip fracture. An updated systematic review to synthesize existing literature on FoF after hip fracture is needed. This review focussed on four research questions: In the hip fracture population: (1) What is the prevalence of FoF?; (2) What FoF assessment tools are validated? (3) What is the relationship between FoF and physical function?; (4) What interventions are effective for reducing FoF?

METHODS

A systematic search was undertaken in EBSCO Health, Scopus and PsychINFO in January 2021 (and updated December 2022) for articles on FoF after hip fracture. Data in relation to each research question was extracted and analysed. The quality of the studies was appraised using the 'Risk of Bias Tool for Prevalence Studies', 'COSMIN Risk of Bias checklist for Patient-reported outcome measures', modified version of the 'Appraisal Tool for Cross-sectional studies', and the 'Cochrane Risk of Bias 2' tools for each research question, respectively.

RESULTS

36 studies (37 articles) with 5099 participants were included (mean age 80.2 years and average 78% female). Prevalence rates for FoF after hip fracture ranged between 22.5% and 100%, and prevalence tended to decrease as time progressed post hip fracture. The 'Falls Efficacy Scale - International' (FES-I) and 'Fear of Falling Questionnaire - Revised' (FFQ-R) were found to be reliable, internally consistent, and valid tools in hip fracture patients. FoF after hip fracture was consistently associated with measures of physical function including balance, gait speed, composite physical performance measures and self-reported function. Ten of 14 intervention studies were considered high risk of bias. Exercise-based interventions with or without a psychological component were not effective in reducing FoF after hip fracture compared to a control condition.

CONCLUSION

FoF is prevalent after hip fracture and is consistently associated with poorer physical function. Only two instruments (FES-I and FFQ-R) have been validated for measuring FoF in the hip fracture population. However, there remains a need for larger, higher quality randomised controlled trials targeting FoF after hip fracture in order to guide clinical practice.

TRIAL REGISTRATION

PROSPERO registration: CRD42020221836.

Factors associated with and 1-year outcomes of fear of falling in a geriatric post-hip fracture assessment

Background

Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences.

Objective

To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF.

Methods

An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4–6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality.

Results

Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating ≥ 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes.

Conclusion

Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.

Delirium and long-term psychopathology following surgery in older adults

OBJECTIVE

To describe the risk of postoperative delirium and long-term psychopathology (depression, anxiety or post-traumatic stress syndrome (PTSS)) in older adults.

METHODS

255 elderly patients (≥ 65 years) undergoing major surgery (planned surgical time > 60 min) in a tertiary hospital were compared to 76 non-surgical controls from general practice. Patients were assessed twice daily for postoperative delirium using the Confusion Assessment Method (CAM(-ICU)), nursing delirium screening scale (NuDESC) and validated chart review. Before surgery and 3 and 12 months thereafter, the participants filled in the Hospital Anxiety and Depression Scale (HADS), the Geriatric Depression Scale (GDS-15) and the Post-Traumatic Stress Syndrome-14-Questions Inventory (PTSS-14). Non-surgical controls filled in the same questionnaires with similar follow-up.

RESULTS

Patients were more often male, had higher American Society of Anesthesiologists scores and more often had a spouse compared to controls (p < 0.005). Forty-three patients (18%) developed postoperative delirium, who were significantly older, had higher ASA scores and lower estimated IQ scores compared to the patients who did not develop delirium (p < 0.05). There were no differences in psychopathology at baseline and 3-month follow-up between patients and controls. At 12-months, surgical patients less frequently scored positive for depression (7% versus 16%) and anxiety (2% versus 10%) compared to nonsurgical controls (p < 0.05). We did not observe differences in occurrence of psychopathology between patients who had and had not developed postoperative delirium.

CONCLUSION

Our results suggest that the older surgical population, with or without postoperative delirium, does not appear to be at greater risk of developing psychopathology. WHY DOES THIS PAPER MATTER?: The older surgical population does not appear to be at greater risk of developing psychopathology, neither seems this risk influenced by the occurrence of postoperative delirium.

The Incidence of Psychologic Stress following a Fall and Surgical Treatment of Distal Radius Fractures

Background and Purpose  Experiencing a fall and a subsequent distal radius fracture can have a major impact not only on patients' physical function, but also on their emotional state. The purpose of this project was to describe the prevalence of fear of falling (FoF) and posttraumatic stress disorder (PTSD) following surgically managed distal radius fractures due to a fall. Methods  Patients who underwent surgery for a distal radius fracture due to a fall were identified by a database query. Patients were divided into three groups based on time from surgery: 0 to 2 weeks (acute), 3 to 6 months (mid-term), and 12 to 15 months (long-term). FoF was measured using the Falls Efficacy Scale-International (FES-I) questionnaire. PTSD was measured using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders (DSM) Text Revision-5 (PCL-5) questionnaire. A total of 239 patients who met inclusion criteria were consented via phone and completed the emailed surveys. Results  FES-I scores were significantly higher in the acute group versus the long-term group ( p  = 0.04). High concern for FoF was observed in 63% (19/30) of patients in the acute group, in 35% (14/40) in the mid-term group ( p  = 0.019 vs. acute), and in 19% (8/42) in the long-term group ( p  < 0.001 vs. acute). Probable PTSD was observed in 2.3% (1/44) of patients in the acute group, in 4.8% (2/42) in the mid-term group, and in 7.3% (3/41) in the long-term group. Conclusion  Patients who undergo surgical fixation of a distal radius fracture due to a fall are subject to FoF and PTSD symptoms. To maximize postoperative outcomes, it is important for surgeons to be aware of these psychological effects and know how to screen for them. Level of Evidence  This is a Level III study.

Incidence of post-traumatic stress disorder in survivors of traumatic fracture: a systematic review and meta-analysis

Post-traumatic stress disorder (PTSD) is prevalent in traumatic events. It is a great hazard of physical and mental health due to their severity and frequency. Traumatic fractures are one of the major causes of PTSD. The incidence of traumatic fractures has been high in recent years, which will directly or indirectly result in PTSD. Our target is to estimate the pooled incidence of PTSD in fracture patients after traumatic events and to explore possible influencing factors by a meta-analysis.The systematic searches in the electronic bibliographic databases of Web of Science, ScienceDirect, Ovid MEDLINE, PubMed, CNKI (China National Knowledge Infrastructure), Wangfang , and Veipu Databases. Not only were heterogeneity and 95% confidence interval (CI) used for comprehensive assessing each pooled, but also was the P value. Subgroup analyses for some sample characteristics were calculated the pooled incidence of PTSD among patients suffered from fractures.In total, 2619 patients suffered from fracture, and were assessed PTSD in the 12 eligible studies. The heterogeneity was not low (I² = 97.6%, P < 0.001) in the 12 eligible studies. The pooled incidence of PTSD in fracture patients was 29% (95% CI, 20% to 39%) using random-effects model. Subgroup analyses revealed that the pooled incidence of PTSD among patients after traumatic fracture was statistically significant differences according to the study design, the study location, tools to assess the symptoms of PTSD, the mean age and injury mechanism (all P < 0.001). Fracture sites, injury mechanism and pain were the main influencing factors of PTSD in fracture patients.Our results highlight the phenomenon that high incidence of PTSD in patients after fracture and they should be followed up regularly and be provided effective interventions. Future efforts to improve and control the main influencing factors of PTSD for this population still needed.

Examining the influence of mental stress on balance perturbation responses in older adults

BACKGROUND

Reach-to-grasp responses following balance perturbations are important to fall prevention but are often ineffective in older adults. The ability to shift attention from an ongoing cognitive task to balance related processes has been shown to influence reach-to-grasp effectiveness in older adults. However, the added influence of stress and anxiety - known to negatively affect attention shifting ability - has not yet been explored in relation to recovery from balance perturbations. Given that fear and anxiety over falling is a key fall risk factor, an understanding of how such a negative mental state may affect postural reactions is important. This study aimed to investigate the effect of varied induced emotional states on reach-to-grasp balance responses in older adults.

METHODS

Healthy older adults (mean age 70.5 ± 5.38 years) stood laterally between 2 handrails with contact sensors. A safety harness with an integrated loadcell was worn to prevent falls and measure the amount of harness assistance (expressed as percent body weight). With instructions to grasp one rail to restore balance, participants' balance was laterally disturbed using surface translations under three randomized conditions: no cognitive task, neutral (verb generation) task, and mental stress task with negative prompts (paced auditory serial addition). The primary outcome was frequency of protective grasps. Secondary outcomes included frequency of harness assistance during trials with grasp errors as well as wrist movement time, trajectory distance, and peak velocity.

RESULTS

Perceived level of distress was highest for the mental stress task compared to no task (p < 0.001) and neutral task conditions (p = 0.008). The mental stress task resulted in the lowest percentage of protective grasps (p < 0.001) in response to balance perturbations. Closer examination of trials that resulted in grasp errors (i.e., collisions or overshoots), revealed increased harness assistance and reduced peak velocity of wrist movement (p < 0.001) under the mental stress condition compared to grasp errors that occurred under the no task or neutral task condition.

DISCUSSION AND CONCLUSION

Distressing mental thoughts immediately prior to a balance perturbation lead to reduced effectiveness in reach-to-grasp balance responses compared to no or neutral cognitive tasks and should be considered as a possible fall risk factor.

Prognostic factors of post-traumatic stress disorder risk in patients with surgical treatment of hip acetabular fracture. Original study

The aim of the study was to assess the risk of developing post-traumatic stress disorder in patients after hip acetabular fracture surgery. The study involved 42 patients fulfilling inclusion criteria. Physical ability levels of the patients were determined with the Harris Hip Score, and modified Merle d’Aubigné scale. High risk of post-traumatic stress disorder was assessed with the PTSD-C questionnaire. Patients had in PTSD-C questionnaire 42.86 ± 28,10 points. In Harris Hip Score 63.64 ± 16.06, in Merle scale 11.10 ± 2.82, that was poor results in both scales. Positive correlation with age reached the level of tendency (ρ = 0.294; p = 0.059). Patients at risk of PTSD were in worse functional state measured by HHS (U = 136.0; p = 0.034) and Merle scale (U = 132.0; p = 0.026) and they were older (U = 147.5; p = 0.068). The groups differed significantly in gender ratio (χ2 = 4.01; p = 0.045). Women (8/10) were more often than men (14/32) at risk of PTSD. Patients after surgical fixation of the acetabulum experience significant functional disability. Increased level of disability after fracture and surgery, older age and female sex make patients vulnerable to PTSD. It is advisable to make medical staff who treat accident victims aware towards aspects which may be related to disorders of the patients’ psychological health.

Risk of Hospitalized Falls and Hip Fractures in 22,103 Older Adults Receiving Mental Health Care vs 161,603 Controls: A Large Cohort Study

OBJECTIVES

To investigate the risk of hospitalized fall or hip fracture among older adults using mental health services.

DESIGN

Retrospective cohort study.

SETTING AND PARTICIPANTS

Residents of a South London catchment aged >60 years receiving specialist mental health care between 2008 and 2016.

MEASURES

Falls and/or a hip fracture leading to hospitalization were ascertained from linked national records. Incidence rates and incidence rate ratios (IRRs) were age- and gender-standardized to the catchment population. Multivariable survival analyses were applied investigating falls and/or hip fractures as outcomes.

RESULTS

In 22,103 older adults, incidence rates were 60.1 per 1000 person-years for hospitalized falls and 13.7 per 1000 person-years for hip fractures, representing standardized IRRs of 2.17 [95% confidence interval (CI) 2.07-2.28] and 4.18 (3.79-4.60), respectively. The IRR for falls was high in those with substance-use disorder [IRR = 6.72 (5.35-8.33)], bipolar disorder [IRR = 3.62 (2.50-5.05)], depression [IRR = 2.28 (2.00-2.59)], and stress-related disorders [IRR = 2.57 (2.10-3.11)]. Hip fractures were increased in all populations (IRR > 2.5), with greatest risk in substance use disorders [IRR = 12.64 (7.22-20.52)], dementia [IRR = 4.38 (3.82-5.00)], and delirium [IRR = 4.03 (3.00-5.29)]. Comparing mental disorder subgroups with each other, after the adjustment for 25 potential confounders, patients with dementia and substance use had a significantly increased risk of falls, and patients with dementia also had an increased risk of hip fractures.

CONCLUSION AND IMPLICATIONS

Older people using mental health services have more than double the incidence of falls and 4 times the incidence of hip fractures compared to the general population. Although incidences differ between diagnostic subgroups, all groups have a higher incidence than the general population. Targeted interventions to prevent falls and hip fractures among older adult mental health service users are urgently needed.

The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: A longitudinal cohort study

INTRODUCTION

A hip fracture can be experienced as a traumatic event that can induce psychological distress. The aim of this study is to give more insight into the prevalence of symptoms of psychological distress in older patients following the first year after a hip fracture. In addition, prognostic factors were determined for psychological distress after hip fracture.

MATERIALS AND METHODS

This hip fracture cohort data was derived from the Brabant Injury Outcome Surveillance, a multicenter longitudinal prospective cohort study. Hip fracture patients (≥65years) admitted to a hospital between August 2015 and November 2016 were asked to complete a questionnaire at 1 week, and 1, 3, 6 and 12 months. The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression and the Impact of Event Scale (IES) was used to assess symptoms of posttraumatic stress (PTS). Prognostic factors were assessed with multivariable logistic mixed models.

RESULTS

In total 570 patients (inclusion rate: 69.7%) were included. The prevalence of psychological distress ranged from 36% at 1 week to 31% at 1 year after hip fracture. Frailty at onset of hip fracture was the most important prognostic factor of symptoms of depression (Odds ratio (OR), 2.74; 95% Confidence interval (CI) 1.41 to 5.34) and anxiety (OR, 2.60; 95% CI 1.15 to 5.85) on average in the year following hip fracture. Frailty was not a prognostic factor of symptoms of PTS (OR, 1.97; 95% CI 0.42 to 9.23).

CONCLUSIONS

The prevalence of psychological distress is high in the first year after a hip fracture. Frailty at onset of a hip fracture is the most important prognostic factor of symptoms of depression and anxiety. These findings have important implications for strategies with early identification of frail patients with a hip fracture at high risk of psychological distress.

Important perioperative factors, guidelines and outcomes in the management of hip fracture

Hip fractures are common injuries in the elderly and are associated with significant morbidity and mortality. There are multiple perioperative factors that must be considered when managing these patients. These include analgesia, timing of surgery, choice of operation, type of anaesthesia, postoperative complications and comorbidities. Guidelines from The National Institute for Health and Care Excellence and the National Hip Fracture Database have been updated to reflect many of the above, but the importance of psychosocial factors is still emerging. This article focuses on the evidence for the key perioperative factors in hip fracture management and the tools available to predict hip fracture outcome.

Correlates of fear of falling and falls efficacy in geriatric patients recovering from hip/pelvic fracture

OBJECTIVE

To gain a better understanding about the nature of fear of falling, this study analyzed associations between psychological and physical aspects related to fear of falling and falls efficacy in hip/pelvic fracture patients.

DESIGN

Baseline data of a randomized controlled trial.

SETTING

Geriatric inpatient rehabilitation hospital.

SUBJECTS

In all, 115 geriatric patients with hip/pelvic fracture (mean age: 82.5 years) reporting fear of falling within first week of inpatient rehabilitation.

INTERVENTIONS

None.

MAIN MEASURES

Falls efficacy (Short Falls Efficacy Scale-International; Perceived Ability to Manage Falls), fear of falling (one-item question), fall-related post-traumatic stress symptoms (six items based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria), physical performance (Short Physical Performance Battery) and psychological inflexibility (Acceptance and Action Questionnaire-II) were assessed.

RESULTS

Path analyses demonstrated that low falls efficacy (Short Falls Efficacy Scale International) was significantly related to poor physical performance (β* = -.277, P ⩽ .001), but not to psychological inflexibility and fall-related post-traumatic stress symptoms (P ⩾ .05.). Fear of falling was directly associated with fall-related post-traumatic stress symptoms (β*= .270, P = .007) and indirectly with psychological inflexibility (β*= .110, P = .022). Low perceived ability to manage falls was significantly related to previous falls (β* = -.348, P ⩽ .001), psychological inflexibility (β* = -.216, P = .022) and female gender (β* = -.239, P ⩽ .01).

CONCLUSION

Falls efficacy and fear of falling constitute distinct constructs. Falls efficacy measured with the Short Falls Efficacy Scale International reflects the appraisal of poor physical performance. Fear of falling measured by the single-item question constitutes a fall-specific psychological construct associated with psychological inflexibility and fall-related post-traumatic stress symptoms.

Concerns for Older Adult Patients with Acute Hip Fracture

PURPOSE

The purpose of this study was to identify concerns among older adult patients with acute hip fracture.

MATERIALS AND METHODS

This study was performed with 152 consecutive patients with hip fracture. Details were obtained on perioperative concerns about hip fracture using a questionnaire that was specifically designed for this study and was administered face to face upon admission. The study inclusion criteria were age older than 65 years and having experienced femur neck, intertrochanteric, or subtrochanteric fracture. The exclusion criteria were not understanding the study purpose, having difficulty communicating, or refusing to participate.

RESULTS

Older adult patients with acute hip fracture expressed concerns regarding excessive pain, medical staff, postoperative recovery, rehabilitation, and hospital expenses. In addition, fear of falling from the bed and anxiety regarding re-fracture were the patients' most significant concerns.

CONCLUSION

Older adult patients reported fear of falling from bed and re-fracture as primary concerns. To overcome these concerns, fracture liaison services to prevent re-fracture should be introduced and enforced.

Better with age? A comparison of geriatric and non-geriatric trauma patients' psychological outcomes 6 months post-injury

This is the first study to compare both physical and psychological outcomes in geriatric and non-geriatric patients (n = 268) at baseline and 6 months post-trauma. Demographic, clinical, and psychological data, including screens for alcohol use, depressive symptoms, and post-traumatic stress symptoms (PTSS) were collected from 67 geriatric patients (70.7 ± 8.0 years) and 201 non-geriatric patients (40.2 ± 12.8 years) admitted to a Level I trauma center for ≥ 24 h. Geriatric patients were significantly less likely to screen positive for alcohol use at baseline, and depression, PTSS, and alcohol use at follow-up. When not controlling for discharge to rehabilitation or nursing facility, geriatric patients had significantly lower odds of alcohol use at follow-up. There was no significant difference in injury severity, resilience, or pre-trauma psychological status between the two groups. Results indicate that geriatric trauma patients fare better than their younger counterparts at 6 months post-trauma on measures of alcohol use, depression, and PTSS. Screenings and interventions for both age groups could improve psychological health post-trauma, but younger patients may require additional attention.

The Role of Prefracture Health Status in Physical and Mental Function After Hip Fracture Surgery

OBJECTIVES

To examine the associations of 3 measures of prefracture health status (physical function, mental function, and comorbidity count) with trajectories of physical and mental function at 1.5, 3, 6, and 12 months after hip fracture surgery.

DESIGN

Single-center observational study.

SETTING

Singapore General Hospital (an acute hospital).

PARTICIPANTS

Patients aged ≥60 years who underwent first hip fracture surgery between June 2011 and July 2016 (N = 928).

INTERVENTION

None.

MEASUREMENTS

We used data collected prospectively from the hospital's hip fracture registry. We used the Short Form-36 (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS) as indicators of physical and mental function, respectively, collected at admission and at 1.5, 3, 6, and 12 months after hip fracture surgery. Comorbidity count at admission was the sum from a list of 10 common diseases associated with poorer physical function.

RESULTS

Prefracture physical function and prefracture mental function demonstrated time-varying associations (interaction P < .001 and P = .001, respectively) with postfracture physical function; the associations were small initially but increased in strength up to 6 months and stabilized thereafter. In contrast, the strength of the association between comorbidity count and postfracture physical function were time-invariant (-0.52, P = .027). The strength of the associations between all 3 measures of prefracture health status and postfracture mental function were also constant over time (0.09, P = .004, for physical function; 0.38, P < .001, for mental function; -0.70, P = .034, for comorbidity count).

CONCLUSIONS/IMPLICATIONS

The time-varying associations between prefracture health status and postfracture physical function suggest that even for patients with good prefracture health status, initial recovery may be slow. Our findings can be useful to clinicians and therapists in their prognostic evaluations and in management of patients' expectation for recovery.