Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study.
BACKGROUND
Hip fracture is common in the elderly. Previous studies suggest that psychiatric illness is common and predicts poor outcome, but have methodological weaknesses. Further studies are required to address this important issue.


METHODS
We prospectively recruited 731 elderly participants with hip fracture in two Leeds hospitals. Psychiatric diagnosis was made within 5 days of surgery using the Geriatric Mental State schedule and other standardized instruments, and data on confounding factors was collected. Main study outcomes were length of hospital stay, and mortality over 6 months after fracture.


RESULTS
Fifty-five per cent of participants had cognitive impairment (dementia in 40% and delirium in 15%), 13% had a depressive disorder, 2% had alcohol misuse and 2% had other psychiatric diagnoses. Participants were likely to remain in hospital longer if they suffered from dementia, delirium or depression. The relative risks of mortality over 6 months after hip fracture were increased in dementia and delirium, but not in depression.


CONCLUSIONS
Psychiatric illness is common after hip fracture, and has significant effects on important outcomes. This suggests a need for randomized, controlled trials of psychiatric interventions in the elderly hip fracture population.
Holmes
J
J
Division of Psychiatry and Behavioural Sciences, University of Leeds.
House
A
A
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003863:Depression / Q000150:complications* / Q000209:etiology; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000401:mortality* / Q000523:psychology*; D006801:Humans; D007902:Length of Stay; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000209:etiology; D008609:Mental Status Schedule; D019965:Neurocognitive Disorders / Q000150:complications* / Q000209:etiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D006113:United Kingdom