Key result
Dementia predicts ~12-fold higher risk of new ADL disability three months after hip fracture.
Why the study?
Predictors of new ADL disability, worsened mobility, and increased care needs after hip fracture in previously independent older adults were not well defined.
Cohort (n=184)
No
Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use predict poor functional outcomes in previously independent older adults following hip fracture.
Answers are grounded in this paper and cite their sources.
Dementia and delirium identify high-risk hip fracture patients for new ADL disability; hypothesis-generating for targeted intervention trials.
OBJECTIVES: To determine predictors of new activities of daily living (ADLs) disability and worsened mobility disability and secondarily increased daily care hours received, in previously independent hip fracture patients. DESIGN: Retrospective cohort study. SETTING: Academic hospital with ambulatory follow-up. PARTICIPANTS: Community-dwelling adults 65 years or older independent in ADLs undergoing hip fracture surgery in 2015 (n = 184). MEASUREMENTS: Baseline, 3- and 6-month ADLs, mobility, and daily care hours received were ascertained by telephone survey and chart review. Comorbidities, medications, and characteristics of hospitalization were extracted from patient charts. Models for each outcome used logistic regression with a backward elimination strategy, adjusting a priori for age, sex, and race. RESULTS: Predictors of new ADL disability at 3 months were dementia (odds ratio [OR] = 11.81; P = .001) and in-hospital delirium (OR = 4.20; P = .002), and at 6 months were age (OR = 1.04; P = .014), dementia (OR = 9.91; P = .001), in-hospital delirium (OR = 3.00; P = .031) and preadmission opiates (OR = 7.72; P = .003). Predictors of worsened mobility at 3 months were in-hospital delirium (OR = 4.48; P = .001) and number of medications (OR = 1.13; P = .003), and at 6 months were age (OR = 1.06; P = .001), preadmission opiates (OR = 7.23; P = .005), in-hospital delirium (OR = 3.10; P = .019), and number of medications (OR = 1.13; P = .013). Predictors of increased daily care hours received at 3 and 6 months were age (3 months: OR = 1.07; P = .014; 6 months: OR = 1.06; P = .017) and number of medications (3 months: OR = 1.13; P = .004; 6 months: OR = 1.22; P = .013). The proportion of patients with ADL disability and care hours received did not change from 3 to 6 months, yet there were significant improvements in mobility. CONCLUSION: Age, dementia, in-hospital delirium, number of medications, and preadmission opiate use were predictors of poor outcomes in independent older adults following hip fracture. Further investigation is needed to identify factors associated with improved mobility measures from 3 to 6 months to ultimately optimize recovery.
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Ouellet et al. (2019) conducted a cohort in Hip fracture (n=184). Dementia and in-hospital delirium vs. Absence of these risk factors was evaluated on New ADL disability at 3 months (OR 11.81, p=.001). Dementia (OR 11.81) and in-hospital delirium (OR 4.20) were significant predictors of new ADL disability at 3 months in previously independent older adults following hip fracture.
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