Functional Predictors for Home Discharge after Hip Fracture in Patients Living in Sloped Neighborhoods or Islands: An 8-Year Retrospective Cohort Study

Yuta Suzuki,Masanori Morikawa,Taizan Shirakawa,Hiroaki Murakami,Noriaki Maeda,Naoki Ishibashi,Junpei Sasadai,Yukio Urabe

doi:10.3390/geriatrics5040093

Abstract

Functional predictors of home discharge after hip fractures have been widely reported; however, no study has considered the geographical features surrounding patients’ homes. This study aimed to identify home discharge predictors and determine the cutoff points required for home discharge of patients living in sloped neighborhoods or islands. A total of 437 postoperative hip fracture patients were included and classified into the flat, slope, and island groups according to their residential area before the fracture. Multivariate logistic regression analysis was used to identify significant home discharge predictors, and receiver-operating characteristic analysis to calculate cutoff values. In all the groups, the functional independence measure-motor score was a significant home discharge predictor, with cutoff values of 69 for the flat group and 65 points for the slope and island group. In the slope group, the 6-minute walking distance (odds ratio, 1.02; 95% confidence interval, 1.01–1.04) and revised Hasegawa dementia scale score (odds ratio, 1.06; 95% confidence interval, 1.01–1.12) were also identified as predictors, with cutoff values of 150 m and 18 points, respectively. The outcomes required for home discharge after hip fracture differ depending on the neighborhood terrain, especially for patients living in areas with many slopes and stairs.

Highlights

Hip fracture is the most common injury that threatens life prognosis in the elderly
On the basis of their place of residence before the fracture, 437 patients were classified into three groups as follows: 193 patients living in flatter neighborhoods (44.2%); 182, in sloped neighborhoods (41.6%); and 62, in islands (14.2%)
141 patients (75.5%) in the flat group, 137 (75.3%) in the slope group, and 53 (85.5%) in the island group were discharged to their own homes

Summary

Introduction

Hip fracture is the most common injury that threatens life prognosis in the elderly. Its incidence rate has continued to increase because of the greater population aging in Japan, and the number of new patients with hip fracture in 2012 was estimated to be 175,700 [1]. The final goal of rehabilitation for patients after hip fracture is to return to their own home and regain their pre-fracture level of activity. 40–57% of patients had improved mobility to the same level as before surgery for hip fracture and 13% were still unable to walk 1 year after surgery [4,5]. In 40–70% of patients, the pre-fracture level of independence in basic activities of daily living (ADL) was regained [6].

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