Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture.
OBJECTIVE
To identify factors associated with postacute rehabilitation outcome of disabled elderly patients with proximal hip fracture.


METHODS
Geriatric rehabilitation center.


METHODS
One hundred thirty-three older patients.


METHODS
Not applicable.


METHODS
FIM instrument, motor FIM score, absolute functional gain on the FIM and motor FIM scores, relative functional gain on the FIM and motor FIM scores, rate of improvement on the FIM and motor FIM scores, proportion of patients discharged to home, and length of stay (LOS).


RESULTS
Mean FIM score improved by 14 points (22%) with a functional gain rate of .56 point per day. No significant differences (P>.05) were found between weight-bearing and non-weight-bearing patients regarding the above outcome measures. Functionally independent and cognitively intact patients achieved significantly better score changes and rates of improvement and showed a higher ability to extract their rehabilitation potential than dependent and cognitively impaired patients. Their LOSs were significantly shorter. Patients with latency time (time delay from fracture to operation) of more than 5 days and patients with a history of stroke had significantly longer LOSs. Mini-Mental State Examination score, albumin levels on admission, and prefracture functional status were the most important parameters associated with FIM discharge scores (r=.756) and relative functional gain on the FIM (r=.583). Depression was the most important factor associated with LOS in patients with weight-bearing instructions on admission. The presence of a caregiver was the significant predictive value variable for returning home.


CONCLUSIONS
Cognitive function, nutritional status, preinjury functional level, and depression were the most important prognostic factors associated with rehabilitation success of older patients with proximal hip fracture. Of these, depression and nutritional status are correctable, and early intervention may improve rehabilitation outcome.
Hershkovitz
Avital
A
Beit Rivka Geriatric Rehabilitation Center, Petach Tikva, Israel. avitalhe@clalit.org.il
Kalandariov
Zulicha
Z
Hermush
Vered
V
Weiss
Roni
R
Brill
Shai
S
D000369:Aged, 80 and over; D017028:Caregivers; D003072:Cognition Disorders / Q000150:complications; D003863:Depression / Q000150:complications; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D016330:Frail Elderly; D006620:Hip Fractures / Q000534:rehabilitation*; D006801:Humans; D007557:Israel; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009483:Neuropsychological Tests; D009752:Nutritional Status; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012044:Regression Analysis; D012709:Serum Albumin / Q000032:analysis; D020521:Stroke / Q000150:complications; D013997:Time Factors
D012709:Serum Albumin