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Multicenter Study
. 2022 Jul;33(7):1465-1475.
doi: 10.1007/s00198-022-06394-y. Epub 2022 Apr 9.

Prognosis and institutionalization of frail community-dwelling older patients following a proximal femoral fracture: a multicenter retrospective cohort study

S A I Loggers  1   2 , T M P Nijdam  3 , E C Folbert  4 , J H H Hegeman  4 , D Van der Velde  3 , M H J Verhofstad  2 , E M M Van Lieshout  5 , P Joosse  1
Affiliations
Multicenter Study

Prognosis and institutionalization of frail community-dwelling older patients following a proximal femoral fracture: a multicenter retrospective cohort study

S A I Loggers et al. Osteoporos Int. 2022 Jul.

Abstract

Hip fractures are a serious public health issue with major consequences, especially for frail community dwellers. This study found a poor prognosis at 6 months post-trauma with regard to life expectancy and rehabilitation to pre-fracture independency levels. It should be realized that recovery to pre-trauma functioning is not a certainty for frail community-dwelling patients.

Introduction: Proximal femoral fractures are a serious public health issue in the older patient. Although a significant rise in frail community-dwelling elderly is expected because of progressive aging, a clear overview of the outcomes in these patients sustaining a proximal femoral fracture is lacking. This study assessed the prognosis of frail community-dwelling patients who sustained a proximal femoral fracture.

Methods: A multicenter retrospective cohort study was performed on frail community-dwelling patients with a proximal femoral fracture who aged over 70 years. Patients were considered frail if they were classified as American Society of Anesthesiologists score ≥ 4 and/or a BMI < 18.5 kg/m2 and/or Functional Ambulation Category ≤ 2 pre-trauma. The primary outcome was 6-month mortality. Secondary outcomes were adverse events, health care consumption, rate of institutionalization, and functional recovery.

Results: A total of 140 out of 2045 patients matched the inclusion criteria with a median age of 85 (P25-P75 80-89) years. The 6-month mortality was 58 out of 140 patients (41%). A total of 102 (73%) patients experienced adverse events. At 6 months post-trauma, 29 out of 120 (24%) were readmitted to the hospital. Out of the 82 surviving patients after 6 months, 41 (50%) were unable the return to their home, and only 32 (39%) were able to achieve outdoor ambulation.

Conclusion: Frail community-dwelling older patients with a proximal femoral fracture have a high risk of death, adverse events, and institutionalization and often do not reobtain their pre-trauma level of independence. Foremost, the results can be used for realistic expectation management.

Keywords: Community-dwelling; Elderly; Geriatric; Hip fracture; Prognosis; Proximal femoral fracture.

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Conflict of interest statement

None.

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