The incidence of mental disorder increases after hip fracture in older people: a nationwide cohort study

Ling-Yin Kuo,Po-Ting Hsu,Chung-Yi Hsu,Tzai-Chiu Yu,Kuang-Ting Yeh,Kuan-Lin Liu,Ru-Ping Lee,Cheng-Huan Peng,Wen-Tien Wu,Hao-Wen Chen,Ing-Ho Chen,Jen-Hung Wang

doi:10.1186/s12877-021-02195-w

Abstract

BackgroundPeople living with dementia seem to be more likely to experience delirium following hip fracture. The association between mental disorders (MD) and hip fracture remains controversial. We conducted a nationwide study to examine the prevalence of MD in geriatric patients with hip fractures undergoing surgery and conducted a related risk factor analysis.Material and methodsThis retrospective cohort study used data from Taiwan’s National Health Insurance Research Database between 2000 and 2012 and focused on people who were older than 60 years. Patients with hip fracture undergoing surgical intervention and without hip fracture were matched at a ratio of 1:1 for age, sex, comorbidities, and index year. The incidence and hazard ratios of age, sex, and multiple comorbidities related to MD and its subgroups were calculated using Cox proportional hazards regression models.ResultsA total of 1408 patients in the hip fracture group and a total of 1408 patients in the control group (no fracture) were included. The overall incidence of MD for the hip fracture and control groups per 100 person-years were 0.8 and 0.5, respectively. Among MD, the incidences of transient MD, depression, and dementia were significantly higher in the hip fracture group than in the control group.ConclusionsThe prevalence of newly developed MD, especially transient MD, depression, and dementia, was higher in the geriatric patients with hip fracture undergoing surgery than that in the control group. Prompt and aggressive prevention protocols and persistent follow-up of MD development is highly necessary in this aged society.

Highlights

People living with dementia seem to be more likely to experience delirium following hip fracture
Among mental disorders (MD), the incidences of transient MD, depression, and dementia were significantly higher in the hip fracture group than in the control group
Prompt and aggressive prevention protocols and persistent follow-up of MD development is highly necessary in this aged society

Summary

Introduction

People living with dementia seem to be more likely to experience delirium following hip fracture. After a severe hip fracture, many active elderly individuals may lose normal physical function [1]. Those with underlying medical problems may no longer be able to live independently, leading to increased need of care. In the frail population of patients with hip fracture, complications after surgery are inevitable, and high incidence rates of pneumonia (5.9%), surgical site infections (5%), and myocardial infarction (1.9%) have been reported [2]. In addition to physical complications, the most frequent complication during admission after hip fracture surgery is delirium, with incidence rates ranging between 23 and 39% [3,4,5]

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