Two-year effects of interdisciplinary intervention for hip fracture in older Taiwanese

Abstract

Objectives: To explore the 2-year outcomes of an interdisciplinary intervention for elderly patients with hip fracture.

Design: Randomized experimental design.

Setting: A 3,000-bed medical center in northern Taiwan.

Participants: Patients with hip fracture (N=162): 80 in the intervention group and 82 in the usual care control group.

Intervention: An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning.

Measurements: Outcomes (clinical outcomes, self-care ability, health-related quality of life (HRQoL), service utilization, and depressive symptoms) were assessed 1, 3, 6, 12, 18, and 24 months after discharge. Self-care ability (ability to perform activities of daily living (ADLs)) was measured using the Chinese Barthel Index. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Survey, Taiwan version (SF-36). Depressive symptoms were measured using the Chinese Geriatric Depression Scale, short form.

Results: Subjects in the intervention group had significantly better ratios of hip flexion (beta=5.43, P<.001), better performance on ADLs (beta=9.22, P<.001), better recovery of walking ability (odds ratio (OR)=2.23, P<.001), fewer falls (OR=0.56, P=.03), fewer depressive symptoms (beta=-1.31, P=.005), and better SF-36 physical summary scores (beta=6.08, P<.001) than the control group during the first 24 months after discharge. The intervention did not affect the peak force of the fractured limb's quadriceps, mortality, service utilization, or SF-36 mental summary score.

Conclusion: The interdisciplinary intervention for hip fracture benefited elderly persons with hip fracture by improving clinical outcomes, self-care ability, and physical health-related outcomes and by decreasing depressive symptoms during the first 24 months after hospital discharge.