Abstract
Background and aims: Hip fractures result in significant functional impairment and a high rate of institutionalization. The aim of our study was to evaluate in patients with a recent hip fracture the contribution of a short (15-min) comprehensive assessment to predict the length of stay and the risk of discharge to a nursing home. Methods: Prospective clinical study conducted in a rehabilitation ward of the Geriatric Hospital. Functional assessment included basic activities of daily living (BADL), cognitive status (MMSE) and a 4-item geriatric depression scale (Mini-GDS). Information on demographic data, living situation, diagnosis and illness burden was also collected. Results: The mean age of the 86 patients (67W/19M) was 84.2±6.8 years. In a multiple regression analysis, the length of stay in a geriatric hospital was significantly associated with both marital status (living alone) (p=0.035) and the intervention of a caregiver on a regular basis (p=0.036), but not with Charlson’s comorbidity score. In a logistic regression model, adjusted for age, gender, marital status, intervention of a caregiver on a regular basis, BADL, Mini-GDS and Charlson’s comorbidity score, the only independent predictor of nursing home admission was a MMSE <24, which increased by 10.7-fold (2.2–50.9) the risk of being admitted to a nursing home (p=0.003). Conclusions: A short comprehensive assessment completed a few days after a hip fracture is useful in predicting length of stay and risk of nursing home admission.
Similar content being viewed by others
References
Fields SD, MacKenzie CR, Charlson ME, et al. Cognitive impairment. Can it predict the course of hospitalized patients? J Am Geriatr Soc 1986; 34: 579–85.
Inouye SK, Wagner DR, Acampora D, et al. A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med 1993; 8: 645–52.
Narain P, Rubenstein LZ, Wieland GD, et al. Predictors of immediate and 6-month outcomes in hospitalized elderly patients. The importance of functional status. J Am Geriatr Soc 1988; 36: 775–83.
Sager MA, Franke T, Inouye SK, et al. Functional outcomes of acute medical illness and hospitalization in older persons. Arch Intern Med 1996; 156: 645–52.
Ceder L, Svensson K, Thorngren KG. Statistical prediction of rehabilitation in elderly patients with hip fractures. Clin Orthop 1980; 52: 185–90.
Koval KJ, Skovron ML, Polatsch D, et al. Dependency after hip fracture in geriatric patients: a study of predictive factors. J Orthop Trauma 1996; 10: 531–5.
Magaziner J, Simonsick EM, Kashner TM, et al. Predictors of functional recovery one year following hospital discharge for hip fracture: a prospective study. J Gerontol 1990; 45: M101–7.
Svensson O, Stromberg L, Ohlen G, et al. Prediction of the outcome after hip fracture in elderly patients. J Bone Joint Surg Br 1996; 78: 115–8.
Matsueda M, Ishii Y. The relationship between dementia score and ambulatory level after hip fracture in the elderly. Am J Orthop 2000; 29: 691–3.
Heruti RJ, Lusky A, Barell V, et al. Cognitive status at admission: does it affect the rehabilitation outcome of elderly patients with hip fracture? Arch Phys Med Rehabil 1999; 80: 432–6.
Huusko TM, Karppi P, Avikainen V, et al. Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ 2000; 321: 1107–11.
Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–83.
Katz S, Ford AB, Moskowitz RW, Jacson BA, Jaffe MW. Studies of illness in the aged: the index of ADL, a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914–9.
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.
Clement JP, Nassif RF, Leger JM, et al. Development and contribution to the validation of a brief French version of the Yesavage Geriatric Depression Scale. Encephale 1997; 23: 91–9.
Young Y, Brant L, German P, et al. A longitudinal examination of functional recovery among older people with subcapital hip fractures. J Am Geriatr Soc 1997; 45: 288–94.
Zuckerman JD, Koval KJ, Aharonoff GB, et al. A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma 2000; 14: 26–30.
Michel JP, Klopfenstein C, Hoffmeyer P, Stern R, Grab B. Hip fracture surgery: is the pre-operative American Society of Anesthesiologists (ASA) score a predictor of functional outcome? Aging Clin Exp Res 2002; 14: 389–94.
March LM, Cameron ID, Cumming RG, et al. Mortality and morbidity after hip fracture: can evidence based clinical pathways make a difference? J Rheumatol 2000; 27: 2227–31.
Schurch MA, Rizzoli R, Mermillod B, et al. A prospective study on socioeconomic aspects of fracture of the proximal femur. J Bone Miner Res 1996; 11: 1935–42.
Van der Sluijs JA, Walenkamp GH. How predictable is rehabilitation after hip fracture? A prospective study of 134 patients. Acta Orthop Scand 1991; 62: 567–72.
Cobey JC, Cobey JH, Conant L, et al. Indicators of recovery from fractures of the hip. Clin Orthop 1976; 117: 258–62.
Mossey JM, Mutran E, Knott K, et al. Determinants of recovery 12 months after hip fracture: the importance of psychosocial factors. Am J Public Health 1989; 79: 279–86.
Hannan EL, Magaziner J, Wang JJ, et al. Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 2001; 285: 2736–42.
Kempen GI, Sanderman R, Scaf-Womp W, et al. The role of depressive symptoms in recovery from injuries to the extremities in older persons. A prospective study. Int J Geriatr Psychiatry 2003; 18: 14–22.
Eastwood EA, Magaziner J, Wang J, et al. Patients with hip fracture: subgroups and their outcomes. J Am Geriatr Soc 2002; 50: 1240–9.
Kennie DC, Reid J, Richardson IR, et al. Effectiveness of geriatric rehabilitative care after fractures of the proximal femur in elderly women: a randomized clinical trial. BMJ 1988; 297: 1083–6.
Goldstein FC, Strasser DC, Woodard JL, et al. Functional outcome of cognitively impaired hip fracture patients on a geriatric rehabilitation unit. J Am Geriatr Soc 1997; 45: 35–42.
Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part I: review of frailty and comprehensive geriatric assessment. Arch Phys Med Rehabil 2003; 84: 890–7.
Wells JL, Seabrook JA, Stolee P, Borrie MJ, Knoefel F. State of the art in geriatric rehabilitation. Part II: clinical challenges. Arch Phys Med Rehabil 2003; 84: 898–903.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Pautex, S., Jacques, MC., Sant, A. et al. A short comprehensive assessment to predict outcome of elderly patients after hip fracture. Aging Clin Exp Res 17, 116–120 (2005). https://doi.org/10.1007/BF03324583
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324583