Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium.
OBJECTIVE
To measure the prevalence of depressive symptoms, cognitive impairment, and delirium in patients with hip fracture and to estimate their effect on functional recovery, institutionalization, and death after surgical repair.


METHODS
Prospective cohort.


METHODS
Hospital, follow-up to community and nursing home.


METHODS
One hundred twenty-six patients aged 65 and older admitted for hip fracture repair.


METHODS
Baseline measurements: Mini-Mental State Examination, Blessed Dementia Rating Scale, Geriatric Depression Scale, prefracture activities of daily living (ADLs), ambulatory status. The Confusion Assessment Method was used to diagnose in-hospital delirium. One- and 6-month outcomes were ADL decline, loss of ambulation, and new nursing home placement or death.


RESULTS
Twenty-two percent of patients had one cognitive or mood disorder, 30% had two, and 7% had three. At 1 month, each cognitive or mood disorder was independently associated with one or more adverse outcome. Considered together, each additional cognitive or mood disorder was associated with greater odds of 1 month outcomes (ADL decline: odds ratio (OR)=1.8, 95% confidence interval (CI)=1.1-2.9; decline in ambulation: OR=1.8, 95% CI=1.1-3.0; nursing home placement or death: OR=3.9, 95% CI=1.9-8.1).


CONCLUSIONS
Cognitive and mood disorders were common in elderly hip fracture patients and were associated with greater risk of poor outcomes, both independently and in combination. Recognition and treatment of these conditions may reduce adverse outcomes in this vulnerable population.
Givens
Jane L
JL
Geriatrics Section, Boston University Medical Center, Boston, Massachusetts 02118, USA. jane.givens@bmc.org
Sanft
Tara B
TB
Marcantonio
Edward R
ER
D000203:Activities of Daily Living; D000368:Aged; D003072:Cognition Disorders / Q000453:epidemiology*; D003693:Delirium / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006620:Hip Fractures / Q000401:mortality / Q000523:psychology* / Q000534:rehabilitation*; D006801:Humans; D007326:Institutionalization / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D020127:Recovery of Function; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology