Factors influencing short-term functional recovery of geriatric hip fracture patients - a prospective observational study

Abstract

Background: Geriatric hip fractures mostly occur due to simple falls in elderly people with advanced osteoporosis and often multimorbid condition. With an incidence of up to 439/100,000 per year hip fractures are very common and are associated with premature death, high rates of morbidity and disability and reduced quality of life. Aim of this study was to investigate the predictive value of cognitive impairment, delirium, depression status, age, gender and function on admission on rehabilitation recovery. Methods: 264 Patients with proximal femoral fracture (ICD 10 S 72.0 – 72.2 (ICD 10)) aged 60 years and older were included when admitted to a postacute geriatric hospital located in Bad Endbach/Germany after fracture repair in one of five different surrounding acute care trauma centers. Permission of full weight bearing during rehabilitation was an inclusion criterion. Exclusion criteria were polytrauma (ISS≥16) and malignancy-related fractures. The recruitment period was from April 1, 2009, to October 31, 2011. The following clinical data and questionnaires were assessed: Barthel Index (BI), Mobility was measured with the Timed Up and Go test (TUG), cognitive impairment was screened with the Mini Mental Status Examination (MMSE), depression was evaluated using the Geriatric Depression Scale short form (GDS), occurence of delirium was recorded with the Delirium Rating Scale (DRS), pain level was measured daily by a Visual Analogue Scale (VAS) (0 = no pain at all to 10 = intolerable pain). With bivariate analysis the BI at discharge and the difference between BI on admission and discharge were compared between the different patient groups according to the other variables. Univariate and multiple regression analysis were performed to identify influencing factors for both the BI at discharge and the difference between BI on admission and at discharge. Results: Duration of inpatient treatment in the rehab hospital was 15days ± 4. Four patients died and 5 patients had to be returned to acute care hospital due to complications. Function of patients improved from a BI score from 31.5 ± 16.8 to a BI mean of 56.6 ± 27.1. Increased age, Depressive symptoms, cognitive impairment and delirious symptoms at rehab start were associated with poor recovery outcomes. Multivariate analyses confirmed delirious symptoms and cognitive impairment as independent predictors for less success in functional recovery during rehabilitation. Conclusion: Rehabilitation success after geriatric hip fracture heavily depends on mental health factors of the patient, especially on cognitive functioning. Further research has to reveal if tailored rehab programmes for demented or delirious patients may be more effective than conventional interventions.