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

Abstract

Background: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

Objectives: To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.

Design: Observational study.

Participants: 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.

Main measures: 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.

Key results: 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 >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.

Conclusions: 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.

Keywords: activities of daily living; function; geriatrics; hip fracture; palliative care.

Fig. 1

Likelihood of returning to pre-hip fracture function in groups stratified by baseline function. This figure presents the proportion of HRS subjects with hip fracture returning to their prior ADL, mobility, and climbing function at the follow-up interview 6 months–2.5 years after the hip fracture (average, 12.5 ± 8.1 months), stratified by their baseline function. a Activities of daily living (ADL). b Walking. c Climbing. Footnote: Baseline function is determined by the pre-hip fracture interview most immediate to the hip fracture event. Returning to pre-hip fracture function was measured by comparing the function reported in the interview 6 months to 2.5 years after the hip fracture to their baseline function (mean 12.5 ± 8.1 months).