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Osteoporosis International
Published in: Osteoporosis International 2/2014

01-02-2014 | Original Article

What determines health-related quality of life in hip fracture patients at the end of acute care?—a prospective observational study

Authors: B. Buecking, J. Struewer, A. Waldermann, K. Horstmann, N. Schubert, M. Balzer-Geldsetzer, R. Dodel, K. Bohl, S. Ruchholtz, C. Bliemel

Published in: Osteoporosis International | Issue 2/2014

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Abstract

Summary

Hip fractures are associated with reduced health-related quality of life (HrQoL). We found pre-existing need of care or limited function, cognitive impairment, and depression to be independent factors associated with lower HrQoL during the postsurgical period. In contrast, joint replacement was associated with better HrQoL compared to internal fixation. Patients’ treatment should be focused on functional recovery and treatment of depression.

Introduction

The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture.

Methods

A total of 402 patients with a mean age of 81 years suffering from a hip fracture were included in this prospective, observational cohort study. HrQoL (determined by the EuroQol instrument) was measured at admission and at discharge from an acute care hospital. Independent factors correlated with HrQoL at discharge and changes from pre-fracture to discharge were determined using multivariate analyses. The influence of antidepressants was evaluated by an ANOVA with repeated measurements.

Results

Need of care prior to fracture was the most important determinant of EQ-5D index at discharge (ß = −0.359, p = 0.003). Additionally, low Mini Mental Status Examination (MMSE) was associated with a lower EQ-5D index at discharge (MMSE 0–9: ß = −0.238, p <0.001; MMSE 10–19: ß = −0.294, p <0.001) and a greater decrease in EQ-5D during hospitalisation (MMSE 10–19: ß = 0.281, p <0.001), while joint replacement (compared to internal fixation) was associated with a higher EQ-5D index (ß = 0.188, p = 0.002) and a lower decrease in the index (ß = −0.216, p = 0.003). EQ VAS values at discharge were correlated with pre-fracture Barthel Index (ß = 0.253, p <0.001) and Geriatric Depression Scale scores (ß = −0.135, p = 0.026). Depressive patients on antidepressants demonstrated less of a decrease in the EQ-5D index compared to patients not receiving medication (F = 2.907, p = 0.090).

Conclusions

Acute care of hip fracture patients should be focused on functional recovery and treatment of depression. When the preferred surgical strategy is unclear, joint replacement should be considered.
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Metadata
Title
What determines health-related quality of life in hip fracture patients at the end of acute care?—a prospective observational study
Authors
B. Buecking
J. Struewer
A. Waldermann
K. Horstmann
N. Schubert
M. Balzer-Geldsetzer
R. Dodel
K. Bohl
S. Ruchholtz
C. Bliemel
Publication date
01-02-2014
Publisher
Springer London
Published in
Osteoporosis International / Issue 2/2014
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-013-2415-5

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