The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

doi:10.1007/s00402-022-04472-8

. 2023 May;143(5):2475-2484.

doi: 10.1007/s00402-022-04472-8. Epub 2022 May 20.

The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

Christina Frölich Frandsen^{1

2}, Maiken Stilling^{3

4

5}, Eva Natalia Glassou^{3

6}, Torben Bæk Hansen^{3

4}

Affiliations

¹ Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark. chfroe@rm.dk.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. chfroe@rm.dk.
³ Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark.
⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
⁶ Department of Quality, Gødstrup Hospital, Herning, Denmark.

PMID: 35596021
DOI: 10.1007/s00402-022-04472-8

The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

Christina Frölich Frandsen et al. Arch Orthop Trauma Surg. 2023 May.

. 2023 May;143(5):2475-2484.

doi: 10.1007/s00402-022-04472-8. Epub 2022 May 20.

Authors

Christina Frölich Frandsen^{1

2}, Maiken Stilling^{3

4

5}, Eva Natalia Glassou^{3

6}, Torben Bæk Hansen^{3

4}

Affiliations

¹ Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark. chfroe@rm.dk.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. chfroe@rm.dk.
³ Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Gødstrupvej 43, 7400, Herning, Denmark.
⁴ Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
⁵ Department of Orthopaedics, Aarhus University Hospital, Aarhus, Denmark.
⁶ Department of Quality, Gødstrup Hospital, Herning, Denmark.

PMID: 35596021
DOI: 10.1007/s00402-022-04472-8

Abstract

Introduction: Hip fracture patients are fragile, and the majority fail to fully recover to their pre-fracture functional level, resulting in an increase in institutionalization. We aimed to investigate risk factors for being dependent at discharge and for failure to return to independent living 12 months after a hip fracture.

Materials and methods: From 2011 to 2017, all surgically treated hip fracture patients admitted from their own homes were included in this prospective cohort study. Patient characteristics were registered, including age, sex, lifestyle, comorbidities, pre-fracture New Mobility Score (NMS), biochemical measures, fracture type, and surgical method. Dependency was measured at discharge using a cumulated ambulatory score (CAS < 6) and the timed-up-and-go test (TUG > 20 s). At 12 months, patients were interviewed regarding residence, NMS, and care needs. Multivariable logistic regression was used, reporting odds ratio (OR) with 95% confidence intervals (CI).

Results: A total of 2006 patients were included in the study with data regarding their hospital stay and discharge. In all, 1342 patients underwent follow-up at 12 months. The risk factors found to be associated with dependency at discharge were mostly static. Modifiable variables associated with dependency at discharge (CAS < 6) were hypoalbuminemia (OR: 1.94, 95% CI 1.38-2.71), not having been mobilized to standing within 24 h (OR: 1.88, 95% CI 1.12-3.15), and general anesthesia (OR: 1.35, 95% CI 1.07-1.71). Failure to return to independent living at 12 months was found in 10% of the patients, and was primarily associated with patient characteristics and proxy variables for comorbidities, but also with dependency at discharge (CAS < 6).

Conclusions: Mobilizing patients to standing within 24 h from hip fracture surgery was vital in maximizing short-term functional recovery. Failure to return to independent living was seen in the frailest patients. However, the majority remained in their own home with little increase in care needs.

Keywords: Cumulated ambulation score; Functional outcome; Functional recovery; Hip fracture; Institutionalization; Timed-up-and-go.

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References

1. World Health Organization 2020 Decade of healthy ageing
1. Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574. https://doi.org/10.1007/s00198-003-1583-0 - DOI - PubMed
1. Dyer SM, Crotty M, Fairhall N et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158. https://doi.org/10.1186/s12877-016-0332-0 - DOI - PubMed - PMC
1. Gamboa-Arango A, Duaso E, Malafarina V et al (2020) Prognostic factors for discharge to home and residing at home 12 months after hip fracture: an anoia hip study. Aging Clin Exp Res 32:925–933. https://doi.org/10.1007/s40520-019-01273-9 - DOI - PubMed
1. Vochteloo AJH, Van Vliet-Koppert ST, Maier AB et al (2012) Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 132:823–830. https://doi.org/10.1007/s00402-012-1469-8 - DOI - PubMed - PMC

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[1] World Health Organization 2020 Decade of healthy ageing

[2] World Health Organization 2020 Decade of healthy ageing

[3] Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574. https://doi.org/10.1007/s00198-003-1583-0 - DOI - PubMed

[4] Osnes EK, Lofthus CM, Meyer HE et al (2004) Consequences of hip fracture on activities of daily life and residential needs. Osteoporos Int 15:567–574. https://doi.org/10.1007/s00198-003-1583-0 - DOI - PubMed

[5] Dyer SM, Crotty M, Fairhall N et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158. https://doi.org/10.1186/s12877-016-0332-0 - DOI - PubMed - PMC

[6] Dyer SM, Crotty M, Fairhall N et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16:158. https://doi.org/10.1186/s12877-016-0332-0 - DOI - PubMed - PMC

[7] Gamboa-Arango A, Duaso E, Malafarina V et al (2020) Prognostic factors for discharge to home and residing at home 12 months after hip fracture: an anoia hip study. Aging Clin Exp Res 32:925–933. https://doi.org/10.1007/s40520-019-01273-9 - DOI - PubMed

[8] Gamboa-Arango A, Duaso E, Malafarina V et al (2020) Prognostic factors for discharge to home and residing at home 12 months after hip fracture: an anoia hip study. Aging Clin Exp Res 32:925–933. https://doi.org/10.1007/s40520-019-01273-9 - DOI - PubMed

[9] Vochteloo AJH, Van Vliet-Koppert ST, Maier AB et al (2012) Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 132:823–830. https://doi.org/10.1007/s00402-012-1469-8 - DOI - PubMed - PMC

[10] Vochteloo AJH, Van Vliet-Koppert ST, Maier AB et al (2012) Risk factors for failure to return to the pre-fracture place of residence after hip fracture: a prospective longitudinal study of 444 patients. Arch Orthop Trauma Surg 132:823–830. https://doi.org/10.1007/s00402-012-1469-8 - DOI - PubMed - PMC

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The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

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The majority of community-dwelling hip fracture patients return to independent living with minor increase in care needs: a prospective cohort study

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