Archives of Orthopaedic and Trauma Surgery

, Volume 134, Issue 2, pp 189–195 | Cite as

Co-morbidities in elderly patients with hip fracture: recommendations of the ISFR-IOF hip fracture outcomes working group

  • Amy Hoang-Kim
  • Jason W. Busse
  • D. Groll
  • P. J. Karanicolas
  • E. Schemitsch
Trauma Surgery



Hip fractures are the second leading cause of hospitalization in the aged and by 2041, epidemiologists forecast an increase in economic cost to $2.4 billion. The hip patient population often presents with comorbidities causing these patients to receive less aggressive medical treatment and have a low quality of life. We believe that physical function is a patient-important outcome for many medical and surgical interventions. The functional co-morbidity index (FCI), unlike prior co-morbidity indices, was developed with physical function as an outcome instead of being designed for administrative purposes or to predict mortality. Our objective was to evaluate the perceptions of practitioners in hip fracture care about the impact of comorbidities on physical function as primary outcome.


We piloted and then distributed a self-administered survey to members of the International Society for Fracture Repair hip fracture outcomes working group. For each of the 18 diagnoses included in the FCI index, we asked in our survey whether the presence of the co-morbidity and whether the severity of the co-morbidity was perceived to impact physical function in patients following a hip fracture.


Seventeen out of 20 respondents completed the questionnaire. The presence and severity of arthritis was ‘strongly’ believed to predict physical function in those with hip fracture (69 and 85.7 %, respectively). Respondents ‘agreed’ (range 53–73 %) that 10/18 diagnoses would predict changes in physical function following hip fracture treatment. Whereas, 63 % of the practitioners‘strongly disagreed’ that diabetes types I and II would change physical function scores. Furthermore, dementia was listed as an additional diagnosis that would affect physical function.


The FCI may provide a useful instrument to predict functional outcome after hip fracture; however, the index may need to be modified for this specific population.


Co-morbidity Hip fracture Elderly Survey Osteoporosis 


  1. 1.
    Canadian Study of Health and Aging Working Group (1994) Canadian Study of Health and Aging: study methods and prevalence of dementia. CMAJ 150:899–913Google Scholar
  2. 2.
    Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper C, Campion G, Melton LJ (1992) Hip fractures in the elderly—a world-wide projection. Osteoporos Int 2:285–289PubMedCrossRefGoogle Scholar
  4. 4.
    Desai MM, Bogardus ST, Williams CS et al (2002) Development and validation of a risk-adjustment index for older patients: the high-risk diagnoses for the elderly scale. J Am Geriatr Soc 50:478–481Google Scholar
  5. 5.
    Extermann M, Overcash J, Lyman G et al (1998) Comorbidity and functional status are independent in older cancer patients. J Clin Oncol 16:1582–1587PubMedGoogle Scholar
  6. 6.
    Fan E, Gifford JM, Chandolu S et al (2012) The functional comorbidity index had high inter-rater reliability in patients with acute lung injury. BMC Anesthesiol 12:21PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Fitzpatrick R (1991) Surveys of patient satisfaction: II. Designing a questionnaire and conducting a survey. BMJ 302:1129–1132PubMedCrossRefGoogle Scholar
  8. 8.
    Fried LP, Ettinger WH, Lind B et al (1999) Physical disability in older adults: a physiological approach. Cardiovascular Health Study Research Group. J Clin Epidemiol 47:747–760CrossRefGoogle Scholar
  9. 9.
    Goldhahn S, Hoang-Kim A, Nakamura N, Goldhahn J (2011) Outcome measures in multicenter studies in a practical guide to research: design, execution and publication. Lubowitz J, Karlsson J, Marx R, Poehling G, Bhandari M (eds) Publication by the international society of arthroscopy, knee surgery, and orthopaedic sports medicine (ISAKOS). Arthroscopy 27(4 Suppl):S83–S93Google Scholar
  10. 10.
    Griffith LE, Cook DJ, Guyatt GH, Charles CA (1999) Comparison of open and closed questionnaire formats in obtaining demographic information from Canadian general internists. J Clin Epidemiol 52:997–1005PubMedCrossRefGoogle Scholar
  11. 11.
    Groll DL, Heyland DK, Caeser M et al (2006) Assessment of long-term physical function in acute respiratory distress syndrome (ARDS) patients. Am J Phys Med Rehabil 85:574–581PubMedCrossRefGoogle Scholar
  12. 12.
    Groll D, To T, Bombardier C et al (2005) The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol 58:595–602PubMedCrossRefGoogle Scholar
  13. 13.
    Hagen KB, Dagfinrud H, Moe RH et al (2012) Exercise therapy for bone and muscle health: an overview of systematic reviews. BMC Med 10:167PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Heyland D, Groll D, Caeser M (2005) Survivors of acute respiratory distress syndrome: relationship between pulmonary dysfunction and long-term health-related quality of life. Crit Care Med 33:1656–1658CrossRefGoogle Scholar
  15. 15.
    Hilligsmann M, Kanis JA, Compston J et al (2013) Health technology assessment in osteoporosis. Calcified Tissue Int 1–14. doi:10.1007/s00223-013-9724-8
  16. 16.
    Hoang-Kim A (2010) The first international society for fracture repair and international osteoporosis foundation “osteoporosis: from evidence to action” combined symposium & working groups. Adv Orthop 2(1):15–18Google Scholar
  17. 17.
    Hoang-Kim A, Beaton D, Bhandari M et al (2013) The need to standardize functional outcome in randomized trials of hip fracture: a review using the ICF framework. J Orthop Trauma 27(1):e1–e8PubMedCrossRefGoogle Scholar
  18. 18.
    Incalzi RA, Capparella O, Gemma A et al (1997) The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med 242:291–298PubMedCrossRefGoogle Scholar
  19. 19.
    Jette AM (1997) Disablement outcomes in geriatric rehabilitation. Med Care 35(6 suppl):JS28–JS37PubMedGoogle Scholar
  20. 20.
    Kaplan MH, Feinstein AR (1974) The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chron Dis 27:387–404PubMedCrossRefGoogle Scholar
  21. 21.
    Kishimoto M, Ojima T, Nakamura Y et al (1998) Relationship between the level of activities of daily living and chronic medical conditions among the elderly. J Epidemiol 8:272–277PubMedCrossRefGoogle Scholar
  22. 22.
    Knaus WA, Draper EA, Wagner DP et al (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829PubMedCrossRefGoogle Scholar
  23. 23.
    Librero J, Peiro S, Ordinana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epi 52(3):171–179CrossRefGoogle Scholar
  24. 24.
    Liu M, Tsuji T, Tsujiuchi K et al (1999) Comorbidities in stroke patients as assessed with a newly developed comorbidity scale. Am J Phys Med Rehabil 78:416–424PubMedCrossRefGoogle Scholar
  25. 25.
    Lohr KN, Aaronson NK, Alonso J et al (1996) Evaluating quality-of-life and health status instruments: development of scientific review criteria. Clin Ther 18(5):979–992PubMedCrossRefGoogle Scholar
  26. 26.
    McNeill JM (1997) Americans with disabilities 1994–1995. Series P70-61, US Department of Commerce, Bureau of the CensusGoogle Scholar
  27. 27.
    Mehravaran S, Coleman AL (2012) The role of vision in preventing falls in the elderly. Aging Health 8(6):549–550CrossRefGoogle Scholar
  28. 28.
    Mokkink LB, Terwee CB, Patrick DL et al (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19:539–549PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Normand SL, Morris CN, Fung KS et al (1995) Development and validation of a claims based index for adjusting for risk of mortality. The case of acute myocardial infarction. J Clin Epidemiol 48:229–243PubMedCrossRefGoogle Scholar
  30. 30.
    Polanczyk CA, Rohde LE, Philbin EA et al (1998) A new case mix adjustment index for hospital mortality among patients with congestive heart failure. Med Care 36:1489–1499PubMedCrossRefGoogle Scholar
  31. 31.
    Rochon PA, Katz JN, Morrow LA et al (1996) Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Med Care 34:1093–1101PubMedCrossRefGoogle Scholar
  32. 32.
    Satariano WA, Ragland DR (1994) The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 120:104PubMedCrossRefGoogle Scholar
  33. 33.
    Shwartz M, Iezzoni LI, Moskowitz M et al (1996) The importance of comorbidities in explaining differences in patient costs. Med Care 34(8):767–782PubMedCrossRefGoogle Scholar
  34. 34.
    Von Korff M, Wagner EH, Saunders K (1992) A chronic disease score from automated pharmacy data. J Clin Epidemiol 45:197–203CrossRefGoogle Scholar
  35. 35.
    Walter LC, Brand RJ, Counsel SR et al (2001) Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 285:2987–2994PubMedCrossRefGoogle Scholar
  36. 36.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  37. 37.
    Ware JE, Snow KK, Kosiniski M et al (1993) SF-36 health survey: manual and interpretation guide. Health Institute, BostonGoogle Scholar
  38. 38.
    Wyrwich KW, Tierney WM, Babu AN et al (2005) A comparison of clinically important differences in health-related quality of life for patients with chronic lung disease, asthma, or heart disease. Health Serv Res 40:577–591PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Amy Hoang-Kim
    • 1
  • Jason W. Busse
    • 2
  • D. Groll
    • 3
  • P. J. Karanicolas
    • 4
  • E. Schemitsch
    • 1
  1. 1.Institute of Medical Sciences, St. Michael’s HospitalUniversity of TorontoTorontoCanada
  2. 2.McMaster UniversityHamiltonCanada
  3. 3.Queen’s UniversityKingstonCanada
  4. 4.Sunnybrook HospitalTorontoCanada

Personalised recommendations