TY - JOUR T1 - Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study. JF - J Gen Intern Med Y1 - 2017 A1 - Victoria L. Tang A1 - Rebecca L. Sudore A1 - Irena Cenzer A1 - W John Boscardin A1 - Alexander K Smith A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Finlayson, Emily A1 - Petrillo, Laura A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Comorbidity KW - Dementia KW - Female KW - Geriatric Assessment KW - Hip Fractures KW - Humans KW - Longitudinal Studies KW - Male KW - Mobility Limitation KW - Recovery of Function KW - Walking AB -

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.

VL - 32 IS - 2 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27605004?dopt=Abstract ER - TY - JOUR T1 - High Levels of Geriatric Palliative Care Needs in Hip Fracture Patients Before the Hip Fracture. JF - J Pain Symptom Manage Y1 - 2016 A1 - Christine S Ritchie A1 - Amy Kelley A1 - Irena Cenzer A1 - Margaret Wallhagen A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged, 80 and over KW - Dementia KW - depression KW - Female KW - Hip Fractures KW - Humans KW - Interviews as Topic KW - Male KW - multimorbidity KW - pain KW - Palliative care KW - Patient Acceptance of Health Care KW - Prodromal Symptoms KW - Vulnerable Populations AB -

CONTEXT: Most hip fracture care models are grounded in curative models where the goal is to return the patient to independent function. In many instances, however, hip fractures contribute to continued functional decline and mortality. Although the negative impact of hip fractures is appreciated once they have occurred, what is less understood is what proportion of older adults have high illness burden before experiencing hip fracture and might benefit from geriatric palliative care.

OBJECTIVES: Using data from the Health and Retirement Study linked to Medicare claims (January 1992 through December 2010), we sought to understand the extent of premorbid illness burden before hip fracture.

METHODS: Characteristics were based on the interview before hip fracture. Features used to indicate need for geriatric palliative care included evidence of functional and medical vulnerability, pain, and depression.

RESULTS: Eight hundred fifty-six older adults who experienced a hip fracture were compared to 851 age-, gender-, and race-matched controls. Older adults with hip fractures had significantly more premorbid functional vulnerability (activities of daily living dependent 25.7% vs. 16.1% [P < 0.001]; dementia 16.2% vs. 7.3% (P < 0.001); use of helpers 41.2% vs. 28.7% [P < 0.001]). They also experienced more medical vulnerability (multimorbidity 43% vs. 29.8% [P < 0.001]; high health care utilization 30.0% vs. 20.9% [P < 0.001]; and poor prognosis 36.1% vs. 25.4% [P < 0.001] in controls). There was no difference in premorbid pain and depression between subsequent hip fracture patients and controls.

CONCLUSIONS: A significant proportion of older adults have evidence of functional and medical vulnerability before hip fracture. For these individuals, integration of geriatric palliative care may be particularly important for optimizing quality of life and addressing the high morbidity experienced by this population.

VL - 52 UR - http://www.sciencedirect.com/science/article/pii/S0885392416302214 IS - 4 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27521282?dopt=Abstract ER - TY - JOUR T1 - One-Year Mortality After Hip Fracture: Development and Validation of a Prognostic Index. JF - J Am Geriatr Soc Y1 - 2016 A1 - Irena Cenzer A1 - Victoria L. Tang A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Espaldon, Roxanne A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - Cause of Death KW - Cohort Studies KW - Comorbidity KW - Disability Evaluation KW - Female KW - Hip Fractures KW - Humans KW - Incidence KW - Longitudinal Studies KW - Male KW - Prognosis KW - Retrospective Studies KW - Risk Assessment KW - Survival Analysis KW - United States AB -

OBJECTIVES: To develop a prediction index for 1-year mortality after hip fracture in older adults that includes predictors from a wide range of domains.

DESIGN: Retrospective cohort study.

SETTINGS: Health and Retirement Study (HRS).

PARTICIPANTS: HRS participants who experienced hip fracture between 1992 and 2010 as identified according to Medicare claims data (N = 857).

MEASUREMENTS: Outcome measure was death within 1 year of hip fracture. Predictor measures were participant demographic characteristics, socioeconomic status, social support, health, geriatric symptoms, and function. Variables independently associated with 1-year mortality were identified, and best-subsets regression was used to identify the final model. The selected variables were weighted to create a risk index. The index was internally validated using bootstrapping to estimate model optimism.

RESULTS: Mean age at time of hip fracture was 84, and 76% of the participants were women. There were 235 deaths (27%) during the 1-year follow up. Five predictors of mortality were included in the final model: aged 90 and older (2 points), male sex (2 points), congestive heart failure (2 points), difficulty preparing meals (2 points), and not being able to drive (1 point). The point scores of the index were associated with 1-year mortality, with 0 points predicting 10% risk and 7 to 9 points predicting 66% risk. The c-statistic for the final model was 0.73, with an estimated optimism penalty of 0.01, indicating very little evidence of overfitting.

CONCLUSION: The prognostic index combines demographic, comorbidity, and function variables and can be used to differentiate between individuals at low and high risk of 1-year mortality after hip fracture.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27295578 IS - 9 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27295578?dopt=Abstract ER - TY - JOUR T1 - Self-Reported Hearing in the Last 2 Years of Life in Older Adults. JF - J Am Geriatr Soc Y1 - 2016 A1 - Christine S Ritchie A1 - Yinghui Miao A1 - W John Boscardin A1 - Margaret Wallhagen KW - Activities of Daily Living KW - Aged KW - Aged, 80 and over KW - California KW - Demography KW - Female KW - Hearing aids KW - Hearing loss KW - Humans KW - Longitudinal Studies KW - Male KW - Middle Aged KW - Prevalence KW - Quality of Life KW - Risk Factors KW - Self Report KW - Vulnerable Populations AB -

OBJECTIVES: To assess the prevalence and correlates of self-reported hearing loss during the last 2 years of life.

DESIGN: Observational cohort study.

SETTING: The Health and Retirement Study (HRS), a longitudinal nationally representative cohort of adults aged 50 and older (2000-13).

PARTICIPANTS: Older adults (N = 5,895, mean age at death 78, 53% female, 20% nonwhite).

MEASUREMENTS: The HRS interview closest to death was used (mean 12.2 months before death). Participants rated their hearing (excellent, very good, good, fair, poor) and indicated whether they used hearing aids. The prevalence and correlates of fair and poor ratings are described, adjusted for age and sex.

RESULTS: Thirty-two percent (95% confidence interval (CI) = 31-34%) of all participants and 60% (95% CI = 57-64%) of the 7% of participants who used hearing aids rated their hearing as fair or poor. The prevalence of fair or poor hearing was highest in participants interviewed closest to death (29% 19-24 months before death, 36% 1-6 months before death, P for trend = .01). Correlates of fair or poor hearing during the last 2 years of life included age at death (50-59, 22%; 60-69, 21%; 70-79, 26%; 80-89, 38%; ≥90, 50%), sex (men 35%, women 30%), race and ethnicity (Hispanic 42%, white 33%), wealth (lowest quartile 38%, highest quartile 27%), history of heart disease (yes 38%, no 27%), activity of daily living dependence (yes 42%, no 26%), difficulty taking medications (yes 46%, no 29%), and probable dementia (yes 44%, no 24%).

CONCLUSION: Self-reported hearing loss increases during the last 2 years of life and is associated with physical and social vulnerability.

VL - 64 UR - http://www.ncbi.nlm.nih.gov/pubmed/27341383 IS - 7 U1 - http://www.ncbi.nlm.nih.gov/pubmed/27341383?dopt=Abstract ER - TY - JOUR T1 - Increase in Disability Prevalence Before Hip Fracture. JF - J Am Geriatr Soc Y1 - 2015 A1 - Irena Cenzer A1 - W John Boscardin A1 - Christine S Ritchie A1 - Margaret Wallhagen A1 - Kenneth E Covinsky KW - Activities of Daily Living KW - Age Factors KW - Aged KW - Aged, 80 and over KW - Dementia KW - Disability Evaluation KW - Disabled Persons KW - Educational Status KW - Female KW - Health Surveys KW - Hip Fractures KW - Humans KW - Income KW - Male KW - Mobility Limitation KW - Prevalence KW - United States AB -

OBJECTIVES: To establish the prevalence and correlates of disability during the 2 years before hip fracture.

DESIGN: Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.

SETTING: The HRS is a nationally representative longitudinal study (1992-2010).

PARTICIPANTS: HRS participants aged ≥65 with hip fracture (mean age at fracture 84, 77% female).

RESULTS: The adjusted prevalence of disability was 20% (95% confidence interval (CI) = 14-25%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44% (95% CI = 33-55%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53%) and for those with dementia (60%).

CONCLUSION: Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.

PB - 63 VL - 63 IS - 10 N1 - Times Cited: 0 0 U1 - http://www.ncbi.nlm.nih.gov/pubmed/26480970?dopt=Abstract U2 - PMC4699653 U4 - medicare/ADMINISTRATIVE DATA/Disabilities/Hip Fractures/ADL/IADL ER -