Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up.
OBJECTIVE
To examine the prevalence, incidence, persistence, predictors, and outcomes of cognitive impairment after hip fracture.


METHODS
Longitudinal cohort study.


METHODS
Eight hospitals in Baltimore, Maryland.


METHODS
Six hundred seventy-four hip fracture patients aged 65 and older living in the community before fracture.


METHODS
Delirium at admission and postsurgery, Mini-Mental State Examination (MMSE) scores postsurgery, and prefracture proxy ratings of MMSE and dementia. Follow-up measures at 2 and 12 months postfracture included mortality, MMSE, physical activities of daily living (PADLs), instrumental activities of daily living (IADLs), social functioning, and the Center for Epidemiologic Studies-Depression Scale.


RESULTS
Overall, 28% had prefracture dementia or MMSE impairment, 8% had cognitive impairment first detected presurgery, 14% had impairment first detected postsurgery, and 50% were not impaired before or during hospitalization. Incident cognitive impairment was more likely in patients who were older, male, and less educated and had more prefracture PADL impairment, intertrochanteric fractures, and higher anesthesia risk ratings. Presurgery incident cases did not differ significantly from those detected postsurgery in functional outcomes or in persistence of cognitive impairment. Cognitive impairment first noted in the hospital persisted through 2 and 12 months in more than 40% of patients. Those with cognitive impairment persisting through 2 months had poorer 12-month PADLs and social functioning.


CONCLUSIONS
Prefracture cognitive impairment and incident cognitive impairment during hospitalization are risk factors for poor functional outcomes. Many incident cognitive problems persisted over 2 to 12 months, and per-sistence predicted later functional and social impairment.
Gruber-Baldini
Ann L
AL
Division of Gerontology, Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. abaldin@epi.umaryland.edu
Zimmerman
Sheryl
S
Morrison
R Sean
RS
Grattan
Lynn M
LM
Hebel
J Richard
JR
Dolan
Melissa M
MM
Hawkes
William
W
Magaziner
Jay
J
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications* / Q000453:epidemiology; D015331:Cohort Studies; D003693:Delirium / Q000150:complications / Q000453:epidemiology; D003704:Dementia / Q000150:complications / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000534:rehabilitation; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D012737:Sex Factors; D013997:Time Factors