Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study
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The aim of this prospective study was to document the functional outcome and quality of life (QoL) over 1 year following hip fracture in elderly women. A total of 159 unselected elderly women with a first hip fracture were matched for age and residence with an equal number of control women. Functional status was measured by completing a Rapid Disability Rating Scale version 2 (RDRS-2) questionnaire [score ranging from 0 (best) to 54 (worse)], before hospital discharge and 12 months later. To examine longitudinal change in health-related QoL, fracture subjects and controls completed the Short Form 36 (SF-36) questionnaire. For the 134 women still alive at 1 year, the mean RDRS-2 score before hospital discharge was 16.2 (95% CI: 15.0–18.0) and 3.5 (2.6–4.3) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean RDRS-2 score improved to 13.0 (11.1–14.1) in hip-fracture women and worsened to 4.3 (3.3–5.0) in the control group (differences with initial scores: P<0.001 in both groups). After adjustment for potential confounders (including age and comorbidity), the estimated functional decline attributable to a hip fracture was 24% in the first year. Poor functional status upon discharge was the strongest predictor of a poor functional status at 1 year. Overall, similar trends were observed when using SF-36 scores as compared with RDRS-2 scores. However, only 51% of the study population was able to complete the SF-36 questionnaire at discharge and after 1 year, and these subjects were considerably younger (P<0.001), had less cognitive impairment (P<0.001), and had better functional status (P<0.001) than those who were unable to complete the SF-36. For those women able to complete the SF-36 questionnaires, the mean SF-36 score before hospital discharge was 56.4 (95% CI: 51.9–60.9) and 71.1 (67.5–74.8) in patients and controls, respectively (P<0.001). During the year following hospital discharge, the mean SF-36 score improved significantly to 61.1 (56.5–65.7) in hip-fracture patients (P=0.03), but remained unchanged in the control group (P=0.23). Overall, the results of this study indicate that women who sustain a hip fracture continue to suffer from substantial functional impairment and loss in QoL at 1 year, despite a significant recovery during this 12-month period. Function upon hospital discharge is the strongest predictor of functional status 1 year later. Assessing QoL in hip fracture women through self-administered questionnaires is subject to considerable bias due to non-response.