Does functional recovery in elderly hip fracture patients differ between patients admitted from long-term care and the community?
BACKGROUND
It is largely unknown whether functional recovery following hip fracture differs between long-term care (LTC) and community-dwelling residents. Our primary purpose was to compare recovery between these patients 6 months following hip fracture, controlling for known prognostic factors. Secondarily, we examined the contribution of residential status, in addition to patient characteristics, to functional recovery.


METHODS
We studied a population-based inception cohort of 451 hip fracture patients >/= 65 years old admitted to one Canadian health region hospital between July 1999 and September 2000. Participants completed the Modified Barthel Functional Index (MBI) in hospital and again via telephone interviews 6 months postoperatively. Data were also collected on surgery and rehabilitation timing, length of hospital stay (LOS). and discharge destination. Relative change from prefracture function adjusting for known prognostic factors, and the proportion of participants returning to prefracture function were compared between the LTC and community-dwelling residents.


RESULTS
LTC residents (n = 115) were older, with lower function prefracture, more comorbidities, and increased dementia than community-dwelling residents (n = 336). Six months postfracture, 17 (22%) LTC and 180 (71%) community-dwelling residents had regained prefracture function (p <.001). LTC residents had 33% lower (-40.6, -27.2) and community-dwelling residents 11.6% lower (-14.8, -8.4) 6-month MBI scores relative to prefracture scores after risk adjustment. Residential status was significantly associated with risk-adjusted functional recovery (p <.001). Median LOS was 4 days less for LTC than for community-dwelling residents (p <.001). Twelve (10%) LTC and 266 (79%) community-dwelling residents were discharged to inpatient rehabilitation (p <.001).


CONCLUSIONS
Following hip fracture, most LTC residents do not regain prefracture function irrespective of known prognostic factors. Further investigation is needed as to the extent to which personal and environmental characteristics contribute to outcome after hip fracture.
Beaupre
Lauren A
LA
PT, 1F1.52 Walter Mackenzie Centre, 8440-112 ST, Edmonton, Alberta, Canada. lbeaupre@cha.ab.ca
Cinats
John G
JG
Jones
C Allyson
CA
Scharfenberger
Angela V
AV
William C Johnston
D
D
Senthilselvan
Ambikaipan
A
Saunders
L Duncan
LD
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D020127:Recovery of Function / Q000502:physiology*; D012111:Residence Characteristics; D012112:Residential Facilities; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome