Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

McGilton, Katherine S.; Chu, Charlene H.; Naglie, Gary; Wyk, Paula M. van; Stewart, Steven; Davis, Aileen M.

doi:10.1111/jgs.14297

Cited by 58 publications

(68 citation statements)

References 38 publications

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“…Although median LOS was 1 day longer than that the pathway required, it was shorter than what reported in most similar studies (22 days vs 28–30) [6, 24–27]. We also found a significant reduction of pain, bedsores, and number of patients with urinary catheter on discharge: these conditions are rarely reported as HF rehabilitation outcomes, although they may impact on clinical complications as well as on functional gain [9, 28].…”

Section: Discussionmentioning

confidence: 71%

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

et al. 2018

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BackgroundDespite progress in surgery and care, hip fracture (HF) remains a catastrophic event, burdened with high risk of mortality and disability. This study aims at identifying predictors of recovering ambulation after intensive inpatient rehabilitation within the Tuscany Region HF rehabilitation pathway.MethodsAll HF patients referred from acute care to the two Massa-Carrara Rehabilitation facilities January 2015–June 2017 were enrolled. Comorbidity Total Score (CIRS) defined high- or low-care setting referral. Recovery of ambulation, with or without aid, (assessed by SAHFE) was the primary outcome. Personal data, comorbidity, cognitive (MMSe) and pre-fracture function (mRANKIN) were recorded on admission. Outcomes included hospital readmission, length of stay (LOS) and home discharge. Urinary catheter, bedsores, disability (modified Barthel Index-mBI), communication disability (CDS), trunk control (TCT), pain (NRS), and ambulation were recorded (admission-discharge).ResultsOf 352 patients enrolled (age 83.9 ± 7.1; 80% women), 1 died and 6 were readmitted to acute-care hospital; 97% patients referred to high-care, and 64% referred to low-care, presented moderate-high comorbidity on admission. Median LOS was 22 days; 95% patients were discharged back home; daily functional gain (mBIscore/LOS) was 1.3 ± 0.7. Patients who recovered ambulation on discharge were 84%. Older age, higher comorbidity, bladder catheter, impaired trunk control, worse cognitive and functional status on admission, and pre-fracture disability were associated to poor outcome, but only higher comorbidity and impaired communication on admission predicted failure to recover ambulation on discharge.ConclusionIn HF patients entitled to intensive inpatient rehabilitation, moderate-high comorbidity and impaired communication are frequent findings and predict rehabilitation failure.

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Section: Discussionmentioning

confidence: 71%

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

et al. 2018

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“…Most of the patients did not reach their pre‐fracture level of mobility . Pre‐facture functional impairment seems to be associated with poor function and mobility in short‐ and mid‐term follow up . Other factors that are associated with poor functional outcome after the different observation periods (6–12 months) are increasing age, living in an institution, poor mental status, female sex, trochanteric fractures, a higher degree of comorbidity and poor functional status after discharge .…”

Section: Introductionmentioning

confidence: 95%

“…8,9 Pre-facture functional impairment seems to be associated with poor function and mobility in shortand mid-term follow up. 7,[10][11][12] Other factors that are associated with poor functional outcome after the different observation periods (6-12 months) are increasing age, 7,8,12,13 living in an institution, 13 poor mental status, 7,12,14,15 female sex, 12 trochanteric fractures, 7 a higher degree of comorbidity 8 and poor functional status after discharge. 13 There is only one retrospective cohort study with functional long-term follow up that reported the Barthel Index 4.9 years after hip fracture.…”

Section: Introductionmentioning

confidence: 99%

Development of the Barthel Index 5 years after hip fracture: Results of a prospective study

Knauf

Buecking

Hack

et al. 2019

Geriatrics Gerontology Int

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Aim The importance of proximal femoral fractures is increasing due to demographic change. Despite appropriate care, these are associated with poor results. We are still lagging behind, and require information on the long‐term functional outcome of these patients and the predictive factors involved. Methods Between 2009 and 2011, 402 patients aged >60 years with hip fractures were included in this prospective observational study. Patients were assessed with the Barthel Index before fracture, at discharge, and 6 months, 1 year and 5 years after surgery. In addition, a variety of parameters (sex, age, fracture type, American Society of Anesthesiologists classification, Mini‐Mental State Examination, housing situation, occurrence of complications during inpatient stay and type of care) were collected to identify the possible independent predictive factors using multivariate analysis. Results The lowest Barthel Index was found at discharge (66 ± 24) for patients from an acute hospital. The Barthel Index improved within the first 6 months (86 ± 21) and decreased afterwards. The factors associated with a significantly higher point loss of the Barthel Index in the multivariate analysis were age (P‐value 0.020), pre‐fracture Barthel Index, (P ≤ 0.001), Mini‐Mental State Examination (P ≤ 0.001) and type II complications (P = 0.001). The other values showed no significant influence on the Barthel Index. Conclusions The present results showed that patients after a hip fracture have a great rehabilitation potential within the first 6 months after the event. More attention should be paid to type II complications and the occurrence of cognitive impairment. Both seem to be a surrogate parameter for the frailty of the patients. Geriatr Gerontol Int 2019; 19: 809–814.

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“…7 Postfracture functional decline has important implications for quality of life and healthcare costs, 8 and it leads to institutionalization in up to 20% of patients. 7 Prior studies in community-dwelling older adults who have sustained hip fracture have included functionally heterogeneous populations 5,[9][10][11][12] and have established that the strongest risk factor for postfracture functional decline is prefracture disability. 5,[9][10][11][12] However, 60% of hip fractures occur in persons without preexisting disability, 13,14 emphasizing the need to understand what factors predict functional decline in this important subgroup.…”

mentioning

confidence: 99%

“…7 Prior studies in community-dwelling older adults who have sustained hip fracture have included functionally heterogeneous populations 5,[9][10][11][12] and have established that the strongest risk factor for postfracture functional decline is prefracture disability. 5,[9][10][11][12] However, 60% of hip fractures occur in persons without preexisting disability, 13,14 emphasizing the need to understand what factors predict functional decline in this important subgroup. Other risk factors for functional decline are age, 11,15 multimorbidity, 9 cognitive impairment, 9,12,16,17 and in-hospital delirium.…”

mentioning

confidence: 99%

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

Ouellet

Romegialli

et al. 2019

J American Geriatrics Society

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OBJECTIVES To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN Retrospective cohort study. SETTING Academic hospital with ambulatory follow‐up. PARTICIPANTS Community‐dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS Baseline, 3‐ and 6‐month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in‐hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in‐hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in‐hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in‐hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION Age, dementia, in‐hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.

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Factors Influencing Outcomes of Older Adults After Undergoing Rehabilitation for Hip Fracture

Cited by 58 publications

References 38 publications

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

Development of the Barthel Index 5 years after hip fracture: Results of a prospective study

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

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