Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study

Abstract

<div class="section"> <a class="named-anchor" id="d3682036e276"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e277">Background</h5> <p id="Par1">Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future. </p> </div><div class="section"> <a class="named-anchor" id="d3682036e281"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e282">Objectives</h5> <p id="Par2">To determine rates of functional recovery in older adults who sustained a hip fracture based on one’s previous function. </p> </div><div class="section"> <a class="named-anchor" id="d3682036e286"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e287">Design</h5> <p id="Par3">Observational study.</p> </div><div class="section"> <a class="named-anchor" id="d3682036e291"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e292">Participants</h5> <p id="Par4">We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function. </p> </div><div class="section"> <a class="named-anchor" id="d3682036e296"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e297">Main Measures</h5> <p id="Par5">Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs. </p> </div><div class="section"> <a class="named-anchor" id="d3682036e301"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e302">Key Results</h5> <p id="Par6">A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score &gt;2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture. </p> </div><div class="section"> <a class="named-anchor" id="d3682036e306"> <!-- named anchor --> </a> <h5 class="section-title" id="d3682036e307">Conclusions</h5> <p id="Par7">Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities. </p> </div>