Does cognitive/physical screening in an outpatient setting predict institutionalization after hip fracture?

Abstract

BackgroundInstitutionalization after hip fracture is a socio-economical burden. We examined the predictive value of Instrumental Activities of Daily Living (IADL) and Mini Mental State Examination (MMSE) for institutionalization after hip fracture to identify patients at risk for institutionalization.MethodsFragility hip fracture patients ≥65 years of age (n = 584) were comprehensively examined at a geriatric outpatient clinic 4 to 6 months after surgery and followed 1 year postoperatively. A telephone interview with a structured inquiry was performed at 1, 4, and 12 months after hip fracture.ResultsAge-adjusted univariate logistic regression analysis revealed that IADL and MMSE scores measured at the outpatient clinic were significantly associated with living arrangements 1 year after hip fracture. Multivariate logistic regression analysis established that institutionalization 1 year after hip fracture was significantly predicted by institutionalization at 4 months (odds ratio [OR] 16.26, 95 % confidence interval [CI] 7.37–35.86), IADL <5 (OR 12.96, 95 % CI 1.62–103.9), and MMSE <20 (OR 4.19, 95 % CI 1.82–9.66). A cut-off value of 5 was established for IADL with 100 % (95 % CI 96 %–100 %) sensitivity and 38 % (95 % CI 33 %–43 %) specificity and for MMSE, a cut-off value of 20 had 83 % (95 % CI 74 %–91 %) sensitivity and 65 % (95 % CI 60 %–70 %) specificity for institutionalization. During the time period from 4 to 12 months, 66 (11 %) patients changed living arrangements, and 36 (55 %) of these patients required more supportive accommodations.ConclusionIADL and MMSE scores obtained 4 to 6 months after hospital discharge may be applicable for predicting institutionalization among fragility hip fracture patients ≥65 years of age at 1 year after hip fracture. An IADL score of ≥5 predicted the ability to remain in the community. Changes in living arrangements also often occur after 4 months.

Understanding the role of social factors in recovery after hip fractures: A structured scoping review

“…We found ten social factors under study in the included articles, which we grouped into three main categories/themes: Social support: (a) intervention to increase social contact (Magaziner, Simonsick, Kashner, Hebel, & Kenzora, ), (b) number of social outings (Cobey et al, ), (c) reported size of social network (Cresci, ; Marottoli, Berkman, Leo‐Summers, & Cooney, ; Mortimore et al, ; Oh & Feldt, ), (d) and social isolation (Landeiro, Gray, & Leal, ). Socioeconomic factors: (a) income (Kristensen, Thillemann, Pedersen, Soballe, & Johnsen, ; Orive et al, ; Shin et al, ; Thorne et al, ), (b) employment (Allegrante et al, ), (c) education and training (Allegrante et al, ; Kristensen et al, ; Shin et al, ; Thorne et al, ), (d) barriers to housing (as an indicator of social deprivation) (Thorne et al, ), (e) and neighbourhood crime rate (as an indicator of social deprivation) (Thorne et al, ). Living arrangement/institutionalisation (Hongisto et al, ; Morghen et al, ; Orive et al, ; Sylliaas et al, ; Thorne et al, ). …”

“…Reported outcomes associated with social factors across studies were divided into three categories: Physical functional recovery: There were eleven articles investigated the relationship between social factors and physical functional recovery after hip fracture (Allegrante et al, ; Cobey et al, ; Cree, Carriere, Soskolne, & Suarez‐Almazor, ; Cresci, ; Egan et al, ; Magaziner et al, ; Marottoli et al, ; Morghen et al, ; Oh & Feldt, ; Orive et al, ; Sylliaas et al, ). The following outcome measures were used: the role‐physical of the 36‐Item Short Form Health Survey (SF‐36) (Allegrante et al, ), the physical summary domain of 12‐Item Short Form Health Survey (SF‐12) (Physical Composite Scale scores [PCS‐12]) (Sylliaas et al, ), Lawton‐Brody Instrumental Activities of Daily Living (IADL) Scale (Orive et al, ), Barthel Activities of Daily Living (ADL) Index (Cree et al, ; Kristensen et al, ; Orive et al, ; Sylliaas et al, ), the Nottingham Extended ADL scale (NEADL) (Sylliaas et al, ), adapted functional activity scale ‘Katz index’ (Cobey et al, ) and informal questions on ADL and IADL (Egan et al, ). Mortality: There were six articles that investigated mortality (Hongisto et al, ; Kristensen et al, ; Marottoli et al, ; Mortimore et al, ; Shin et al, ; Thorne et al, ) as measured by death records at various time points post fracture (30 days, 2 months, 6 months, 1 year). Other outcomes: There were six articles investigated other outcomes including: pain, measured by visual analogue scale (VAS) (Orive et al, ), health‐related quality of life as measured by the SF‐36 total score (Gambatesa et al, ), hospital length of stay in days (Kristensen et al, ; Landeiro et al, ) and two articles that investigated the effect on institutionalisation after hip fracture (Hongisto et al, ; Marottoli et al, ). …”

“…For many of the studies, their results are limited by their small sample size, which decreased power and significance level of the research and therefore affected our findings (Gambatesa et al, ; Rathbun et al, ). Furthermore, several studies assessed functional status using proxy report, which may be less accurate than an objective evaluation administered by a trained professional (Cenzer et al, ; Cree et al, ; Hongisto et al, ; Mortimore et al, ). Another limitation was that we did not search qualitative or grey literature.…”

“…All studies collected data on post-fracture outcomes except for two studies that also looked at pre-fracture subjective recalled outcomes (Cobey et al, 1976;Mortimore et al, 2008). Fifteen studies primarily investigated the relationship between social factors and recovery post hip fracture, whereas four studies looked at social factors as a secondary objective (Hongisto, Nuotio, Luukkaala, Vaisto, & Pihlajamaki, 2016;Morghen et al, 2011;Orive et al, 2016;Sylliaas et al, 2012).…”

Effects of 12-month home-based physiotherapy on duration of living at home and functional capacity among older persons with signs of frailty or with a recent hip fracture - protocol of a randomized controlled trial (HIPFRA study)

“…In western countries 10–20% of the persons are institutionalized when evaluated 6–12 months after the hip fracture [13], and 11% change their dwelling (from home to institution or vice versa) during 4–12 months after the fracture [14]. At one year since the fracture 42% of the patients have not recovered to their pre-fracture mobility level, and 29% do not achieve the same level of activities of daily living that they had before the fracture [15].…”