A CRITICAL REVIEW OF THE LONG-TERM DISABILITY OUTCOMES FOLLOWING HIP FRACTURE

Abstract

Hip fractures are a common consequence of falls and are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people’s abilities and quality of life (QOL) over the medium to long term. Cohort studies of hip fracture patients reporting outcomes three months post-fracture or longer were reviewed. Outcomes of mobility, participation in domestic and community activities of daily living (ADLs), health or quality of life were categorised according to the World Health Organization’s International Classification of Functioning. Risk of bias was assessed based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. The review included 38 studies, most followed participants from the time of fracture and included a clearly defined sample. This review showed that most recovery occurs within six months after fracture; 40–60% of survivors recover their pre-fracture level of mobility and ability to perform instrumental ADLs and 40–70% regain their level of independence for basic ADLs. For survivors independent in self-care pre-fracture, 20–60% require assistance for various tasks 1–2 years after fracture. Hip fracture has a significant impact on QOL; 10–20% of survivors are institutionalised following fracture, with poorer outcomes for people living in residential care pre-fracture. These studies indicate the range of current outcomes rather than potential improvements with different interventional approaches. Future studies should measure impact on life participation and determine the proportion of people that regain their pre-fracture level of functioning to investigate strategies for improving these important outcomes.