Use of Early Indicators in Rehabilitation Process to Predict One-Year Mortality in Elderly Hip Fracture Patients

Abstract

Hip fractures remain one of the most devastating injuries in the elderly. Early prediction of outcome following hip fracture potentially results in more efficient health care. The aims of this study were to explore predictors of ambulation status at hospital discharge in patients ≥65 years of age operated on for fracture of the hip, and to investigate the impact of ambulation status at hospital discharge on 1-year mortality after hip fracture. We studied 344 patients who underwent surgery for hip fracture during a 12 month period. Multivariate regression analysis was used to explore predictive factors for ambulatory status at discharge, and 1-year mortality adjusted on important baseline variables. Cumulative 1-year mortality was significantly lower for patients in the ambulatory group when compared to patients in the non-ambulatory group. Patients who were older, had severe cognitive impairment, lower functional level before injury, and in whom postoperative delirium and pressure ulcers occurred had a higher chance of not recovering their gait ability at hospital discharge, and being dead 1 year after hip fracture. Inability to walk at hospital discharge and presence of delirium are independent predictors of 1-year mortality. Every effort should be made to assure early mobilisation after hip fracture surgery, and prevention, prompt recognition and treatment of postoperative complications is important in order to facilitate better short-and long-term outcome.

Older people with hip fracture transferred to intermediate care: outcomes in an integrated health and social care model

“…15 Patients with delirium in the perioperative period have also been shown to have poorer functional recovery, higher rates of institutionalisation and higher mortality rates. [16][17][18][19] The relationship of diagnoses of delirium and dementia with admission rates to intermediate care, readmission rates to hospital and final discharge destination, have not heretofore been studied in a UK hip fracture population.…”

Prediction of Ambulatory Status After Hip Fracture Surgery in Patients Over 60 Years Old

“…In patients over 60 years old with hip fracture, early mobilization is an important issue, because the ambulatory status is a predictive factor for 1-year mortality after hip surgery [5]. Therefore, for regaining quality of life and with respect to mortality after hip fracture, recovery of the ambulatory capacity is important.…”

Postoperative Delirium in the Geriatric Patient

“…[1–5] Postoperative delirium has a reported incidence from 10% to 70% depending on the criteria used for diagnosis, the population studied, and the type of surgical procedure. Higher incidences tend to be reported in the oldest, most medically-complex patients following vascular, cardiac, or hip fracture operations.…”