19 Hip Fracture Outcomes in the Frail Older Person

Abstract

Abstract Background Hip fractures in the older person are associated with significant morbidity and mortality. Screening patients for frailty and assessing baseline mobility and function may help predict poorer outcomes Methods All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between February 2016-February 2018 were included. We assessed clinical frailty score(CFS), zuckermann functional recovery score(FRS) and new mobility score(NMS) on admission and at 1 year. Outcomes assessed included mortality rates and nursing home(NH) admission rates Results 541 patients were included; 533 underwent surgery, 4 died preoperatively and 4 of the periprosthetic fracture cohort were treated conservatively. 33 patients lost to follow-up. Overall mortality was 24.7%(n=134) at one year. In the severely frail cohort (CFS7-9)(n=72); 47.2% mortality rate at 1 year. 20.8%(n=15) came from home, 2 of those were discharged to NH. In the moderately frail cohort (CFS 5-6)(n= 184), mortality rate was 30.4% at 1 year. 77.2%(n=142) were admitted from home and 8%(n=15) of this cohort were discharged to NH. In the non-frail subgroup (CFS 1-4)(n=211), mortality rate was 11.8%(n= 25)at 1 year, 97.1% (n=205) were admitted from home and 7.5%(n=11) of the cohort admitted from home were living in a NH at 1 year. Regarding FRS; compared to those without frailty(FRS>75), those with FRS 30-75 had a two-fold increased risk of one year mortality [OR: 2.16 (95% CI: 1.24 to 3.78)]. This increased to a nearly six-fold increased risk in those with severe frailty (FRS<30); [OR 5.73 (95%CI : 3.16 -10.41)]. This effect was independent of age. A dementia diagnosis independent of age and frailty is associated with 2.5 fold increased risk of NH/mortality at 1 year Conclusion All three tools (CFS, NMS, FRS) can accurately predict mortality and NH admission at 1 year. Patients with higher CFS and poor baseline functioning and mobility have poorer outcomes. CFS is a simple tool that can be documented on admission with a hip fracture and help inform discussions with patients and families regarding potential outcomes/prognosis.