Published in:
01-07-2017
Hip fractures in older patients: Trajectories of disability after surgery
Published in: The journal of nutrition, health & aging | Issue 7/2017
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Background
Hip fracture in older patients often lead to permanent disabilities and can result in mortality.
Objective
To identify distinct disability trajectories from admission to one-year post-discharge in acutely hospitalized older patients after hip fracture.
Design
Prospective cohort study, with assessments at admission, three-months and one-year post-discharge.
Setting and participants
Patients ≥ 65 years admitted to a 1024-bed tertiary teaching hospital in the Netherlands.
Methods
Disability was the primary outcome and measured with the modified Katz ADL-index score. A secondary outcome was mortality. Latent class growth analysis was performed to detect distinct disability trajectories from admission and Cox regression was used to analyze the effect of the deceased patients to one-year after discharge.
Results
The mean (SD) age of the 267 patients was 84.0 (6.9) years. We identified 3 disability trajectories based on the Katz ADL-index score from admission to one-year post-discharge: ‘mild’- (n=54 (20.2%)), ‘moderate’- (n=110 (41.2%)) and ‘severe’ disability (n=103 (38.6%)). Patients in all three trajectories showed an increase of disabilities at three months, in relation to baseline and 80% did not return to baseline one-year post-discharge. Seventy-three patients (27.3%) deceased within one-year post-discharge, particularly in the ‘moderate’- (n=22 (8.2%)) and ‘severe’ disability trajectory (n=47 (17.6%)).
Conclusions
Three disability trajectories were identified from hospital admission until one-year follow-up in acutely hospitalized older patients after hip fracture. Most patients had substantial functional decline and 27% of the patient’s deceased one-year post-discharge, mainly patients in the ‘moderate’- ‘and severe’ disability trajectories.