Osteoporosis International

, Volume 25, Issue 2, pp 475–484 | Cite as

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

  • B. Buecking
  • J. Struewer
  • A. Waldermann
  • K. Horstmann
  • N. Schubert
  • M. Balzer-Geldsetzer
  • R. Dodel
  • K. Bohl
  • S. Ruchholtz
  • C. Bliemel
Original Article

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.

Keywords

Function Geriatric fracture Hip fracture Mobility Outcome Quality of life 

Notes

Conflicts of interest

Each author certifies that he or she and members, or a member of his/her immediate family, have no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose as a conflict of interest in connection with the content of the submitted article.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2013

Authors and Affiliations

  • B. Buecking
    • 1
  • J. Struewer
    • 2
  • A. Waldermann
    • 1
  • K. Horstmann
    • 3
  • N. Schubert
    • 1
  • M. Balzer-Geldsetzer
    • 3
  • R. Dodel
    • 3
  • K. Bohl
    • 3
  • S. Ruchholtz
    • 1
  • C. Bliemel
    • 1
  1. 1.Department of Trauma, Hand and Reconstructive SurgeryUniversity of Giessen and Marburg GmbHMarburgGermany
  2. 2.Department of Orthopedics and RheumatologyUniversity of Giessen and Marburg GmbHMarburgGermany
  3. 3.Department of NeurologyUniversity of Giessen and Marburg GmbHMarburgGermany

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