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

TitleRates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.
Publication TypeJournal Article
Year of Publication2017
AuthorsTang, VL, Sudore, RL, Cenzer, IStijacic, W Boscardin, J, Smith, AK, Ritchie, CS, Wallhagen, M, Finlayson, E, Petrillo, L, Covinsky, KE
JournalJ Gen Intern Med
Volume32
Issue2
Pagination153-158
Date Published2017 Feb
ISSN Number1525-1497
KeywordsActivities of Daily Living, Age Factors, Aged, Aged, 80 and over, Comorbidity, Dementia, Female, Geriatric Assessment, Hip Fractures, Humans, Longitudinal Studies, Male, Mobility Limitation, Recovery of Function, Walking
Abstract

BACKGROUND: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

OBJECTIVES: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.

DESIGN: Observational study.

PARTICIPANTS: We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.

MAIN MEASURES: Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.

KEY RESULTS: A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.

CONCLUSIONS: 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.

DOI10.1007/s11606-016-3848-2
User Guide Notes

http://www.ncbi.nlm.nih.gov/pubmed/27605004?dopt=Abstract

Alternate JournalJ Gen Intern Med
Citation Key8678
PubMed ID27605004
PubMed Central IDPMC5264672
Grant ListK24 AG029812 / AG / NIA NIH HHS / United States
K24 AG054415 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States
T32 AG000212 / AG / NIA NIH HHS / United States