Associations of sex, Alzheimer's disease and related dementias, and days alive and at home among older Medicare beneficiaries recovering from hip fracture

Abstract

BackgroundMales constitute 25% of older adults who experience hip fractures in the United States; a concerning upward trend given poorer health and outcomes among male survivors. Male sex is associated with worse cognitive performance after hip fracture, impacting participation in rehabilitation and long‐term outcomes especially for those with Alzheimer's disease or related dementias (ADRD). However, little research has evaluated whether sex differences in post‐fracture recovery are greater among those living with ADRD.MethodsData were drawn from 2010 to 2017 Medicare fee‐for‐service beneficiaries aged 65 years and older who survived hospitalization for hip fracture (n = 69,581). The primary outcome was days alive and at home (DAAH), a validated patient‐centered claims‐based outcome calculated as 365 days from fracture minus days in hospital, nursing home, rehabilitation facility, emergency department, or time after death. Multivariable Poisson regressions with an interaction term between sex and ADRD status were to model the association between DAAH and ADRD in the 12 months post hip fracture, adjusting for demographics, injury severity, chronic disease burden, and hospital‐level fixed effects.ResultsCompared to females, males were younger and had more comorbidities at the time of fracture. Among survivors, males with ADRD spent a mean of 160.7 DAAH compared to 228.4 for males without ADRD, 177.8 for females with ADRD, and 248.0 for females without ADRD. In adjusted analyses, males without ADRD spent 8.2% fewer DAAH compared to females (rate ratio [RR] = 0.92, 95% CI 0.92–0.92). This relative sex difference increased significantly when comparing those living with ADRD, with males spending an additional 3.3% fewer DAAH (interaction RR = 0.96, 95% CI 0.96–0.97).ConclusionsMales spend fewer DAAH after hip fracture than females, and this difference increases modestly for males living with ADRD compared to females. This suggests that cognitive impairment may be a small but significant contributor to sex‐based differences observed during hip fracture recovery.

Cognitive assessment to optimize prediction of functional outcome in subacute hip fracture: a short-term prospective study

“…Impaired cognition has been significantly associated with high mortality rates, 1 , 2 increased risk of recurrent fractures and prosthetic hip dislocations, 3 , 4 blunted ability to function in activities of daily living, 5 , 6 impaired mobility, 7 low likelihood of discharge home and reduced number of days alive and at home, a combined patient-centered outcome measure. 8 , 9 The recent results are in agreement with a lot of previous original studies and various systematic reviews: on the whole, the wider literature has consistently reported poor outcomes in cognitively impaired subjects with a fragility fracture of the hip. 10 - 12 Notably, the presence of cognitive impairment has been associated with poor outcomes independently of many potential confounders.…”

Impact of dementia and socioeconomic disadvantage on days at home after traumatic brain injury among older Medicare beneficiaries: A cohort study

“…Consistent with our prior work, home time was calculated by subtracting the number of days spent in an inpatient, skilled nursing facility, nursing home, emergency department observation, or outpatient observation setting (i.e., patient is in the hospital but has not been technically admitted), and the number of days spent deceased, from the total follow‐up available for each of the 12 follow‐up months (monthly level) 33,34 . This definition of home time extends prior work to include emergency department and outpatient observation settings, which are technically not time spent at home 22,35 .…”