The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study.

Abstract

Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12months after a hip fracture. From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS < 6) and the timed-up-and-go test (TUG > 20s). At 12months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI). A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS < 6) were hypoalbuminemia (OR: 1.94, 95% CI 1.38-2.71), not having been mobilized to standing within 24h (OR: 1.88, 95% CI 1.12-3.15), and general anesthesia (OR: 1.35, 95% CI 1.07-1.71). Failure to return to independent living at 12months was found in 10% of the patients, and was primarily associated with patient characteristics and proxy variables for comorbidities, but also with dependency at discharge (CAS < 6). Mobilizing patients to standing within 24h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.