title: Does early functional outcome predict 1-year mortality in elderly patients with hip fracture?
abstract: BACKGROUND
  Hip fractures in the elderly are followed by considerable risk of functional decline and mortality.
  
  
  OBJECTIVE
  The purposes of this study were to (1) explore predictive factors of functional level at discharge, (2) evaluate 1-year mortality after hip fracture compared with that of the general population, and (3) evaluate the affect of early functional outcome on 1-year mortality in patients operated on for hip fractures.
  
  
  METHODS
  A total of 228 consecutive patients (average age, 77.6 ± 7.4 years) with hip fractures who met the inclusion criteria were enrolled in an open, prospective, observational cohort study. Functional level at discharge was measured with the motor Functional Independence Measure (FIM) score, which is the most widely accepted functional assessment measure in use in the rehabilitation community. Mortality rates in the study population were calculated in absolute numbers and as the standardized mortality ratio. Multivariate regression analysis was used to explore predictive factors for motor FIM score at discharge and for 1-year mortality adjusted for important baseline variables.
  
  
  RESULTS
  Age, health status, cognitive level, preinjury functional level, and pressure sores after hip fracture surgery were independently related to lower discharge motor FIM scores. At 1-year followup, 57 patients (25%; 43 women and 14 men) had died. The 1-year hip fracture mortality rate compared with that of the general population was 31% in our population versus 7% for men and 23% in our population versus 5% for women 65 years or older. The 1-year standardized mortality rate was 341.3 (95% CI, 162.5-520.1) for men and 301.6 (95% CI, 212.4-391.8) for women, respectively. The all-cause mortality rate observed in this group was higher in all age groups and in both sexes when compared with the all-cause age-adjusted mortality of the general population. Motor FIM score at discharge was the only independent predictor of 1-year mortality after hip fracture.
  
  
  CONCLUSIONS
  Functional level at discharge is the main determinant of long-term mortality in patients with hip fracture. Motor FIM score at discharge is a reliable predictor of mortality and can be recommended for clinical use.
authors.affiliation: Clinic for Physical Medicine and Rehabilitation, Clinical Center Serbia, Faculty of Medicine, University of Belgrade, Pasterova 2, 11000, Belgrade, Serbia. edubljaninraspopovic@gmail.com
authors.forename: Emilija
authors.initials: E
authors.lastname: Dubljanin-Raspopović
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Marković-Denić
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinković
authors.forename: Una
authors.initials: U
authors.lastname: Nedeljković
authors.forename: Marko
authors.initials: M
authors.lastname: Bumbaširević
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000401:mortality*; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000175:diagnosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality* / Q000534:rehabilitation; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
references.citation: J Am Geriatr Soc. 1975 Oct;23(10):433-41
references.pmid: 1159263
references.citation: JAMA. 2004 Apr 14;291(14):1738-43
references.pmid: 15082701
references.citation: Aging Clin Exp Res. 2006 Oct;18(5):381-7
references.pmid: 17167302
references.citation: Osteoporos Int. 2005 Jul;16(7):729-36
references.pmid: 15526089
references.citation: Clin Orthop Relat Res. 1984 Jun;(186):45-56
references.pmid: 6723159
references.citation: Gerontology. 2009;55(5):496-504
references.pmid: 19628932
references.citation: Public Health. 2003 May;117(3):196-201
references.pmid: 12825470
references.citation: BMJ. 2005 Dec 10;331(7529):1374
references.pmid: 16299013
references.citation: J Gerontol. 1990 May;45(3):M101-7
references.pmid: 2335719
references.citation: Am J Phys Med Rehabil. 2000 Mar-Apr;79(2):184-92
references.pmid: 10744194
references.citation: Cochrane Database Syst Rev. 2009 Oct 07;(4):CD007125
references.pmid: 19821396
references.citation: Stud Health Technol Inform. 2009;146:511-5
references.pmid: 19592896
references.citation: J Trauma. 1995 Aug;39(2):261-5
references.pmid: 7674394
references.citation: Clin Orthop Relat Res. 2001 Sep;(390):232-43
references.pmid: 11550871
references.citation: Can J Anaesth. 2008 Mar;55(3):146-54
references.pmid: 18310624
references.citation: J Am Geriatr Soc. 2003 Jul;51(7):1002-6
references.pmid: 12834522
references.citation: Injury. 2011 Nov;42(11):1205-13
references.pmid: 21232743
references.citation: N Engl J Med. 1999 Mar 4;340(9):669-76
references.pmid: 10053175
references.citation: Aging Clin Exp Res. 2002 Oct;14(5):389-94
references.pmid: 12602574
references.citation: Adv Wound Care. 1999 Jan-Feb;12(1):22-30
references.pmid: 10326353
references.citation: J Am Geriatr Soc. 2000 May;48(5):546-9
references.pmid: 10811548
references.citation: J Am Geriatr Soc. 2009 May;57(5):863-70
references.pmid: 19484841
references.citation: J Bone Joint Surg Am. 2006 Sep;88(9):2060-8
references.pmid: 16951125
references.citation: CMAJ. 2010 Oct 19;182(15):1609-16
references.pmid: 20837683
references.citation: J Am Geriatr Soc. 2000 Jun;48(6):618-24
references.pmid: 10855596
references.citation: J Bone Joint Surg Am. 2006 Oct;88(10):2115-23
references.pmid: 17015586
references.citation: J Adv Nurs. 2007 Mar;57(5):494-504
references.pmid: 17284276
references.citation: Ann Epidemiol. 2007 Jul;17(7):514-9
references.pmid: 17420142
references.citation: Lancet. 2002 Jun 1;359(9321):1929-36
references.pmid: 12057569
references.citation: Osteoporos Int. 2009 Oct;20(10):1633-50
references.pmid: 19421703
references.citation: Arch Phys Med Rehabil. 2006 Feb;87(2):167-71
references.pmid: 16442967
references.citation: J Am Geriatr Soc. 1988 Jun;36(6):525-30
references.pmid: 2897391
references.citation: Eur J Surg. 2000 Jun;166(6):480-5
references.pmid: 10890545
references.citation: J Am Geriatr Soc. 2008 Jun;56(6):1075-9
references.pmid: 18422945
references.citation: BMC Musculoskelet Disord. 2011 May 20;12:105
references.pmid: 21599967
references.citation: Age Ageing. 1999 Oct;28(6):551-6
references.pmid: 10604507
references.citation: Psychosom Med. 2003 Jul-Aug;65(4):688-94
references.pmid: 12883123
references.citation: Anesthesiology. 1978 Oct;49(4):239-43
references.pmid: 697077
references.citation: Arch Phys Med Rehabil. 2006 Oct;87(10):1382-7
references.pmid: 17023250
references.citation: Osteoporos Int. 2004 Feb;15(2):87-94
references.pmid: 14605799
references.citation: J Bone Joint Surg Am. 2008 Jul;90(7):1436-42
references.pmid: 18594090
references.citation: J Gerontol A Biol Sci Med Sci. 2000 Sep;55(9):M498-507
references.pmid: 10995047
references.citation: J Am Geriatr Soc. 2009 Jul;57(7):1175-83
references.pmid: 19486198
references.citation: Arch Intern Med. 2002 Feb 25;162(4):457-63
references.pmid: 11863480
references.citation: Arch Phys Med Rehabil. 2007 Jul;88(7):916-21
references.pmid: 17601474