Skip to main content
SpringerLink
Log in

Hip fractures in older patients: Trajectories of disability after surgery

  • Published:
The journal of nutrition, health & aging

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Table 1
Figure 1
Table 2
Table 3

Similar content being viewed by others

References

  1. Dubljanin-Raspopovic E, Markovic-Denic L, Matanovic D, Grajic M, Krstic N, Bumbasirevic M. Is pre-fracture functional status better than cognitive level in predicting short-term outcome of elderly hip fracture patients? Arch Med Sci 2012; 29: 115–22.

    Article  Google Scholar 

  2. Eastwood EA, Magaziner J, Wang J, Silberzweig SB, Hannan EL, Strauss E, et al. Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 2002; 50: 1240–49.

    Article  PubMed  Google Scholar 

  3. Tseng M, Shyu YL, Liang J. Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontol 2012; 52: 833–42.

    Article  Google Scholar 

  4. Chudyk AM, Jutai JW, Petrella RJ, Speechley M. Systematic review of hip fracture rehabilitation practices in the elderly. Arch Phys Med Rehabil 2009; 90: 246–62.

    Article  PubMed  Google Scholar 

  5. Vergara I, Vrotsou K, Orive M, Gonzalez N, Garcia S, Quintana JM. Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study. BMC Geriatr 2014; 14: 124.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Mathew RO, Hsu WH, Young Y. Effect of comorbidity on functional recovery after hip fracture in the elderly. Am J Phys Med Rehabil 2013; 92: 686–96.

    Article  PubMed  Google Scholar 

  7. McCusker J, Kakuma R, Abrahamowicz M. Predictors of functional decline in hospitalized elderly patients: a systematic review. J Gerontol A Biol Sci Med Sci 2002; 57: M569–77.

    Article  PubMed  Google Scholar 

  8. Neuman MD, Siber JH, Magaziner JS, Passarella MA, Mehta S, Werner RM. Survival and functional outcomes after hip fracture among nursing home residents. JAMA internal medicine 2014; 174: 1273–80.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 2000; 55: 498–507.

    Article  Google Scholar 

  10. Gill T, Murphy T, Gahbauer E, Allore H. The course of disability before and after a serious fall injury. JAMA internal medicine 2013; 173: 1780–86.

    Article  PubMed  Google Scholar 

  11. Aronow HU, Sharkey P, Siebens HC, Horn SD, Smout RJ, De Jong G, et al. Initial recovery trajectories among patients with hip fracture: a conceptual approach to exploring comparative effectiveness in postacute care. The American academy of physical medicine and rehabilitation 2012; 4: 264–72.

    Google Scholar 

  12. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of Illness in the Aged. the Index of Adl: a Standardized Measure of Biological and Psychosocial Function. JAMA 1963; 21: 914–19.

    Google Scholar 

  13. Weinberger M, Samsa GP, Schmader K, Greenberg SM, Carr DB, Wildman DS. Comparing proxy and patients’ perceptions of patients’ functional status: results from an outpatient geriatric clinic. J Am Geriatr Soc 1992; 40: 585–88.

    Article  CAS  PubMed  Google Scholar 

  14. White DK, Wilson JC, Keysor JJ. Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT). Arthritis Care Res (Hoboken) 2011: 63: S297–307.

    Article  Google Scholar 

  15. Laan W, Zuithoff NP, Drubbel I, Bleijenberg N, Numans ME, de Wit NJ, et al. Validity and reliability of the Katz-15 scale to measure unfavorable health outcomes in community-dwelling older people. J Nutr Health Aging 2014: 18:848–54.

    Article  CAS  PubMed  Google Scholar 

  16. Folstein MF, Folstein SE, McHugh PR. «Mini-mental state». A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189–98.

    CAS  PubMed  Google Scholar 

  17. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990: 15;113(12): 941–948.

    Google Scholar 

  18. Charlson Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987: 40: 373–83.

    Article  PubMed  Google Scholar 

  19. Jones BL, Nagin DS. Advances in group-based trajectory modeling and an SAS procedure for estimating them. Socio Meth Res 2007; 35: 5 42–71.

    Google Scholar 

  20. Nagin DS. Group-based modeling of development. Harvard University Press; 2005

    Book  Google Scholar 

  21. Smith T. Pre-operatieve indicators for mortality following hip fracture surgery: a systematic review. Age and Ageing 2014; 43: 464–471.

    Article  PubMed  Google Scholar 

  22. Morton de N, Keating JL, Jeffs K. Exercise for acutely hospitalized older medical patients. Cochrane review 2009.

    Google Scholar 

  23. Vellas B, Fielding R, Miller R, Rolland Y, Bhasin S, Magaziner J, Bischoff-Ferrari H on behalf of the ICFSR task force members. Designing drug trials for sarcopenia in older adults with hip fracture–a task force from the international conference on frailty and sarcopenia research (ICFSC). J Frailty Aging 2014: 3(4): 199–204.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Amsterdam School of Physiotherapy, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, the Netherlands

    J. J. Aarden, M. van der Esch, R. H. H. Engelbert & M. van der Schaaf

  2. ACHIEVE Center of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands

    J. J. Aarden, R. H. H. Engelbert, M. van der Schaaf & B. M. Buurman

  3. Department of Internal Medicine, Section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

    S. E. de Rooij & B. M. Buurman

  4. Academic Medical Center, Department of Rehabilitation, University of Amsterdam, Amsterdam, the Netherlands

    J. J. Aarden, R. H. H. Engelbert & M. van der Schaaf

  5. University Medical Center Groningen, Amsterdam, the Netherlands

    S. E. de Rooij

  6. Reade Center of Rehabilitation and Rheumatology, Amsterdam, the Netherlands

    M. van der Esch

Authors
  1. J. J. Aarden
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. van der Esch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. H. H. Engelbert
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. van der Schaaf
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. E. de Rooij
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. M. Buurman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. J. Aarden.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aarden, J.J., van der Esch, M., Engelbert, R.H.H. et al. Hip fractures in older patients: Trajectories of disability after surgery. J Nutr Health Aging 21, 837–842 (2017). https://doi.org/10.1007/s12603-016-0830-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-016-0830-y

Keywords

Search

Navigation