What determines health-related quality of life in hip fracture patients at the end of acute care?—a prospective observational study
- 800 Downloads
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.
The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture.
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.
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).
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.
KeywordsFunction Geriatric fracture Hip fracture Mobility Outcome Quality of life
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.
- 4.Federal bureau of statistics. Germany. Hospital statistics. Wiesbaden 2011;https://www.destatis.de/DE/Publikationen/Thematisch/Gesundheit/Krankenhaeuser/DiagnosedatenKrankenhaus2120621097004.pdf?__blob=publicationFile
- 16.Gjertsen JE, Vinje T, Lie SA, Engesaeter LB, Havelin LI, Furnes O, Fevang JM (2008) Patient satisfaction, pain, and quality of life 4 months after displaced femoral neck fractures: a comparison of 663 fractures treated with internal fixation and 906 with bipolar hemiarthroplasty reported to the Norwegian Hip Fracture Register. Acta Orthop 79:594–601PubMedCrossRefGoogle Scholar
- 25.ICD-10 Version:2010. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Available at: http://apps.who.int/classifications/apps/icd/icd10online/. Accessed 2 May 2012
- 26.Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196Google Scholar
- 27.Anesthesiologists ASo ASA physical status classification system(2010) http://www.asahq.org/clinical/physicalstatus.htm. Accessed 2 May 2012
- 29.EQ-5-D;A standardised instrument for use as a measure of health outcome;User Giude; 2009;http://www.euroqol.org/fileadmin/user_upload/Documenten/PDF/User_Guide_v2_March_2009.pdf. Accessed 2 May 2012
- 32.Sheikh JI, Yesavage JA (1986) Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. In: Brink TL (ed) Clinical gerontology: a guide to assessment and intervention. Haworth, New York, pp 165–173Google Scholar
- 35.Arbeitsgemeinschaft Wissenschaftlich Medizinischer Fachgesellschaften (AWMF) (2009) S3-guideline „dementia“, long version. http://www.awmf.de. Accessed 10 July 2012
- 38.König HH, Heider D, Lehnert T, Riedel-Heller SG, Angermeyer MC, Matschinger H, Vilagut G, Bruffaerts R, Haro JM, de Girolamo G, de Graaf R, Kovess V, Alonso J, ESEMeD/MHEDEA 2000 investigators (2010) Health status of the advanced elderly in six European countries: results from a representative survey using EQ-5D and SF-12. Health Qual Life Outcomes 8:143PubMedCentralPubMedCrossRefGoogle Scholar
- 42.Silverman S, Viswanathan HN, Yang YC, Wang A, Boonen S, Ragi-Eis S, Fardellone P, Gilchrist N, Lips P, Nevitt M, Palacios Gil-Antuñano S, Pavelka K, Revicki D, Simon J, Macarios D, Siris ES (2012) Impact of clinical fractures on health-related quality of life is dependent on time of assessment since fracture: results from the FREEDOM trial. Osteoporos Int 23:1361–1369PubMedCrossRefGoogle Scholar
- 46.Network GR Acute care Hip Fracture Clinical Pathway October 2011 http://www.gtarehabnetwork.ca/clinical-care-guidelines-hip-fracture Accessed 25 Dec 2011.
- 47.(SIGN) SIGN Management of hip fracture in older people—a national clinical guideline http://www.sign.ac.uk/pdf/sign111.pdf Accessed 25 Dec 2011.
- 48.Leitlinie Schenkelhalsfraktur, Deutsche Gesellschaft für Unfallchirurgie, 2008, http://www.awmf.org/uploads/tx_szleitlinien/012-001_S2e_Schenkelhalsfraktur_leitlinientext_05-2008_05-2013.pdf Accessed 14 Jun 2011.
- 50.Papaioannou A, Kennedy CC, Ioannidis G, Sawka A, Hopman WM, Pickard L, Brown JP, Josse RG, Kaiser S, Anastassiades T, Goltzman D, Papadimitropoulos M, Tenenhouse A, Prior JC, Olszynski WP, Adachi JD, Group CS (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714PubMedCrossRefGoogle Scholar
- 51.AQUA – Institut für angewandte Qualitätsförderung und Forschung im Gesundheitswesen. Bundesauswertung zum Erfassungsjahr 2011. 17/1 - Hüftgelenksnahe Femurfraktur. Qualitätsindikatoren. www.aqua-institut.de. Accessed 31 May 2012