Abstract
BackgroundA restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture.MethodsA prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis.ResultsSix months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function.ConclusionIn our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.
Highlights
A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome
This paper presents new data on the role of factors influencing functional prognosis after accidental hip fracture in a comprehensive manner, including traditionally studied individual-based factors such as sex, age, previous level of functioning and health status, and, other factors related to the medical care provided and the socioeconomic sphere
In total, 857 patients were initially included in the study, all having attended the Emergency Room (ER) services of one of the six participating hospitals for a hip fracture following an accidental fall
Summary
A restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. The prevalence of falls in elderly people has been found to be between 14 and 32% according to various epidemiological studies [2,3,4]. These rates have remained steady in our setting over the last fifteen years [5]. Falls have severe consequences in elderly individuals [6], from a physical [6,7] as well as a psychological perspective [8]. Among community-dwelling elderly people, the prevalence of fractures after falls varies between 7.8 and 16.5% [4,5]. The most frequent fractures from a fall are hip and Colles fractures [3], and the most frequent severe complication of a fall event is the occurrence of a hip fracture
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