Abstract
BackgroundHip fracture in older adults is associated with depression and frailty. This study examined the synergistic effects of depression and hip fracture on physical frailty, and the mediating role of the cortisol:dehydroepiandrosterone sulphate (DHEAS) ratio.MethodsThis was an observational longitudinal study of patients with a hip fracture carried out in a hospital setting and with follow up in the community.Participants were 101 patients aged 60+ years (81 female) with a fractured neck of femur.Measurements of the ability to carry out activities of daily living (ADL), cognitive function, physical frailty and assays for serum cortisol and DHEAS were performed six weeks and six months post-hip fracture. Depressed and non-depressed groups were compared by ANOVA at each time point.ResultsHip fracture patients who developed depression by week six (n = 38) had significantly poorer scores on ADL and walking indices of frailty at both week six and month six, and poorer balance at week six. The association with slower walking speed was mediated by a higher cortisol:DHEAS ratio in the depressed group.ConclusionDepression following hip fracture is associated with greater physical frailty and poorer long term recovery post-injury. Our data indicate that the underlying mechanisms may include an increased cortisol:DHEAS ratio and suggest that correcting this ratio for example with DHEA supplementation could benefit this patient population.
Highlights
Hip fracture in older adults is associated with depression and frailty
Reasons for withdrawal between week 6 and month 6 included: death or being too unwell to be tested (N = 17), not being able to continue in the study for a variety of reasons including feeling they had too much to cope with, receiving treatment for depressive symptoms or other medication/illnesses on the list of exclusion criteria, or being non-contactable (N = 18)
In conclusion, depression emerging post-hip fracture in older adults impairs physical function, including walking speed, balance, and activities of daily living
Summary
Hip fracture in older adults is associated with depression and frailty. This study examined the synergistic effects of depression and hip fracture on physical frailty, and the mediating role of the cortisol: dehydroepiandrosterone sulphate (DHEAS) ratio. The factors influencing recovery from hip fracture are poorly understood depression is a common co-morbidity in these patients [4]. The prevalence rate for depression in hip fracture patients across eight US and UK studies ranged from 9–47% [5]. Depression coincident with the physical trauma of hip fracture may accelerate progression from health to frailty. Understanding the mechanisms mediating the link between depression and poor health outcomes after hip fracture may reveal novel approaches to improving recovery
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