Abstract
OBJECTIVE: To evaluate the changes in short-term cognitive function and the relation between cognition and early post-operative functional outcome in the elderly following a hip fracture DESIGN: Prospective pre-test-post-test observational study SETTING: Two public hospitals in Johannesburg, South Africa PARTICIPANTS: Ninety elderly patients with a first time unilateral hip fracture over the age of 60 years were consecutively sampled. Patients with polytrauma and those with co-morbidities affecting mobility (stroke, Parkinson's disease or a spinal cord injury) were excluded. Patients re-admitted with complications of a previous surgery or those managed conservatively were also excluded. Seventy-two participants completed the study DATA COLLECTION: Pre-operative (baseline), discharge and six weeks post discharge assessments were carried out. Cognitive function was established using the Six-Item Cognitive Impairment Test (6CIT) at each of the three assessment periods. The participants' post-operative functional level was assessed using the Elderly Mobility Scale (EMS) and the Lower Extremity Functional Scale (LEFS) at discharge and at six weeks post discharge RESULTS: This study revealed significant advances in cognition from baseline to six weeks post discharge (z-statistic -5.04, p=0.000). After adjusting for pre-fracture functional mobility and pre-existing co-morbidities, a multivariate regression analysis revealed that cognitive function is also a strong predictor of early post-operative functional outcome (β= -0.14, p=0.036 CONCLUSION: Cognitive function in elderly individuals with a hip fracture does improve over time. Cognitive function is a strong predictor of early post-operative functional outcome, when adjusted for pre-fracture functional mobility and pre-existing co-morbidities
Highlights
Hip fracture is a common, serious injury that occurs predominantly in the elderly.1 Hip fractures are a major cause of morbidity and mortality and occur in 20% to 30% of older people who fall.2Cognitive function has been reported to be an important prognostic factor associated with rehabilitation success of older patients with a hip fracture
Cognitive function in elderly individuals with a hip fracture does improve over time
Patients with a hip fracture who present with cognitive impairments and depressive symptoms have poorer rehabilitation outcomes, which is due to poor participation during therapy
Summary
Hip fracture is a common, serious injury that occurs predominantly in the elderly. Hip fractures are a major cause of morbidity and mortality and occur in 20% to 30% of older people who fall.2Cognitive function has been reported to be an important prognostic factor associated with rehabilitation success of older patients with a hip fracture. Hip fracture is a common, serious injury that occurs predominantly in the elderly.. Impaired cognitive function may negatively affect functional recovery in disabled elderly patients with a hip fracture.. Patients with a hip fracture who present with cognitive impairments and depressive symptoms have poorer rehabilitation outcomes, which is due to poor participation during therapy.. There are no studies available in South Africa that have evaluated the changes in short-term cognitive function, from a pre-operative state to discharge and six weeks post discharge, and the relation between cognition and early post-operative functional outcome in the elderly following a hip fracture prior to this study. The aim of this study was to establish these changes in cognitive function and determine the relation between cognitive function and the early post-operative functional outcome in elderly patients with a hip fracture
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