Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study

Tang, Victoria; Sudore, Rebecca L.; Cenzer, Irena Stijacic; Boscardin, W. John; Smith, Alex; Ritchie, Christine S.; Wallhagen, Margaret; Finlayson, Emily; Petrillo, Laura; Covinsky, Kenneth E.

doi:10.1007/s11606-016-3848-2

Cited by 117 publications

(83 citation statements)

References 21 publications

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“…As to this secondary analysis, we must mention the exclusion of 28 patients, either due to death/acute care readmission or missing data. However, these patients presented lower SDC and higher comorbidity on admission and overall worse outcome, thus suggesting that their exclusion was not a substantial bias to our final results, that are in line with some [9, 27], but not all studies focusing on HF recovery [25, 26, 32, 33]. Indeed, we must also point out that our model, although significant, explained only 24% of the variance of the final outcome; as we already acknowledged, the lack of information on the first stages of care and on surgery (timing, type) is the main limitation of our study, and, probably, our model would have been empowered by including this information [24, 27].…”

Section: Discussionsupporting

confidence: 82%

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: Discussionsupporting

confidence: 82%

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

et al. 2018

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“…Due to the high rates of cognitive impairment in this population and the association of cognitive impairment with poor functional recovery after surgical insults in older adults, the likelihood of undergoing a breast cancer surgery and having it impact a frail, elderly woman’s function in the long-term is plausible and likely. 15 …”

Section: Discussionmentioning

confidence: 99%

Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents

et al. 2018

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“…The finding of improvement in mobility measures, specifically climbing stairs and walking two blocks, between 3-and 6-month follow-up is particularly important when considering that prior studies in functionally heterogeneous populations demonstrated no significant change in function. 7,37 This finding highlights the need for additional investigation to the postoperative rehabilitation course, to ascertain those factors that may optimize the ability for recovery of mobility independence.…”

Section: Discussionmentioning

confidence: 96%

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

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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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Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study

Abstract: Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.

Cited by 117 publications

References 21 publications

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

Predictors of recovering ambulation after hip fracture inpatient rehabilitation

Functional Status and Survival After Breast Cancer Surgery in Nursing Home Residents

Functional Outcomes After Hip Fracture in Independent Community‐Dwelling Patients

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