Decline in physical function following hip fracture

Abstract

Objective: The main objective of the study was to determine the change in physical function following hip fractures in a community-living elderly population. A secondary objective was the determination of baseline factors predictive of altered function following hip fracture.

Design: Prospective, cohort study.

Setting: Urban, community-living elders.

Participants: 120 members of a cohort of 2806 individuals age 65 and older in New Haven, CT who sustained a hip fracture from 1982 to 1988 and were treated in the two New Haven hospitals.

Outcome measure: Self-reported performance of dressing, transferring, walking across a room, climbing stairs, and walking one-half mile before the fracture occurred and 6 weeks and 6 months post-fracture. Baseline factors were assessed before the hip fracture occurred.

Results: Of the 120 cohort members who sustained a hip fracture in the 6-year study period, 22 died within 6 months of the fracture. Among survivors there was a sustained decline in function at 6 weeks after the fracture with little improvement by 6 months. At baseline, 86% could dress independently versus 49% at 6 months; 90% could transfer independently versus 32% at 6 months; 75% could walk across a room independently versus 15% at 6 months; 63% could climb a flight of stairs versus 8% at 6 months; and 41% could walk one-half mile versus 6% at 6 months. Physical function and mental status were the only baseline factors significantly associated with physical function at 6 months after the fracture in bivariate analysis, while physical function and depression were associated in multivariate analysis.

Conclusion: We found a substantial decline in physical function following hip fracture in a prospectively followed community-living elderly population. Only pre-morbid physical and mental function predicted this decline.