Can functional status, after rehabilitation, independently predict long-term mortality of hip-fractured elderly patients?
OBJECTIVE
Hip fractures are one of the most serious causes of functional impairment and death in the elderly. The aim of this study was to evaluate prospectively the predictive value of functional performance, after rehabilitation, of hip fracture on long-term mortality in community-dwelling patients.


METHODS
One hundred and seventy-one patients aged 60 years and over, admitted to a geriatric rehabilitation day unit after inpatient rehabilitation, were followed for up to 4 years. Main outcome measures were Functional Independent Measure (FIM), Timed Get Up and Go test (GUAG), cognitive status using the Mini-Mental State Examination on admission, and mortality during the follow-up period. Kaplan-Meier analysis was carried out on survival curves.


RESULTS
All 24 deceased patients performed the GUAG test in > 20 seconds. Although approaching significance, the survival curves were not statistically different between patients performing the test in < or = 20 and those performing it in > 20 seconds (p = 0.08). Survival curves were significantly higher in patients with a FIM score of > or = 90 (p = 0.004), no cardio-cerebrovascular (CCV) diseases (p = 0.001) and no diabetes mellitus (p = 0.01). There were no differences in survival according to age, gender, educational level, marital status, surgical vs conservative treatment, and cognition. A multivariate analysis including FIM score, CCV diseases and diabetes mellitus, demonstrated that only CCV disease was an independent variable for survival (p = 0.02).


CONCLUSIONS
Performance, as evidenced by FIM scores after rehabilitation for hip fracture, may provide additional useful information on long-term survival. However, since functional status after rehabilitation is not an independent risk factor for long-term mortality, its predictive value must be interpreted in view of the comorbidities, mainly CCV diseases, which are more important to the risk of mortality than the event of hip fracture itself.
Beloosesky
Yichayaou
Y
Department of Geriatrics, Rabin Medical Center, Beilinson Campus, Sackler School of Medicine, Tel Aviv University, Petach Tikvah, Israel. belo-7@zahav.net.il
Weiss
Avraham
A
Grinblat
Joseph
J
Brill
Shai
S
Hershkovitz
Avital
A
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004185:Disability Evaluation; D005260:Female; D006620:Hip Fractures / Q000401:mortality* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012047:Rehabilitation Centers; D015996:Survival Rate; D016896:Treatment Outcome