Abstract
BackgroundImpairment in activities of daily living (ADL) is an important predictor of outcomes although many administrative databases lack information on ADL function. We evaluated the impact of ADL function on predicting postoperative mortality among older adults with hip fractures in Ontario, Canada.MethodsSociodemographic and medical correlates of ADL impairment were first identified in a population of older adults with hip fractures who had ADL information available prior to hip fracture. A logistic regression model was developed to predict 360-day postoperative mortality and the predictive ability of this model were compared when ADL impairment was included or omitted from the model.ResultsThe study sample (N = 1,329) had a mean age of 85.2 years, were 72.8% female and the majority resided in long-term care (78.5%). Overall, 36.4% of individuals died within 360 days of surgery. After controlling for age, sex, medical comorbidity and medical conditions correlated with ADL impairment, addition of ADL measures improved the logistic regression model for predicting 360 day mortality (AIC = 1706.9 vs. 1695.0; c -statistic = 0.65 vs 0.67; difference in - 2 log likelihood ratios: χ2 = 16.9, p = 0.002).ConclusionsDirect measures of ADL impairment provides additional prognostic information on mortality for older adults with hip fractures even after controlling for medical comorbidity. Observational studies using administrative databases without measures of ADLs may be potentially prone to confounding and bias and case-mix adjustment for hip fracture outcomes should include ADL measures where these are available.
Highlights
Impairment in activities of daily living (ADL) is an important predictor of outcomes many administrative databases lack information on ADL function
ADL impairment is imbalanced between comparison groups [16]. This potential confounding may be problematic in observational studies of older adults with complex chronic diseases given that ADL impairment may be a stronger predictor of some outcomes such as long-term care (LTC) placement or mortality than some commonly used measures of medical comorbidity [17,18,19]
A total of 37 articles reported on medical conditions or patient characteristics associated with basic ADL impairment (Additional file 3)
Summary
Impairment in activities of daily living (ADL) is an important predictor of outcomes many administrative databases lack information on ADL function. This potential confounding may be problematic in observational studies of older adults with complex chronic diseases given that ADL impairment may be a stronger predictor of some outcomes such as LTC placement or mortality than some commonly used measures of medical comorbidity [17,18,19] Comorbidity indices, such as the Charlson comorbidity score [20,21], the Johns Hopkins Adjusted Clinical Groups (ACG) system [22], or measures based on prescription medications [23], can be constructed from information in many administrative databases to risk adjust outcomes and control for confounding. There have been only a few studies which have evaluated the impact of ADL impairment on predicting outcomes in administrative databases [19,24,25] and there is limited information available on strategies to minimize the potential bias that may result when direct measures of ADL impairment are not available
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