title: What determines health-related quality of life in hip fracture patients at the end of acute care?--a prospective observational study.
abstract: Hip fractures are associated with reduced health-related quality of life (HrQoL). We found pre-existing need of care or limited function, cognitive impairment, and depression to be independent factors associated with lower HrQoL during the postsurgical period. In contrast, joint replacement was associated with better HrQoL compared to internal fixation. Patients' treatment should be focused on functional recovery and treatment of depression.
  
  
  BACKGROUND
  The aim of the study was to identify independent factors that were correlated with health-related quality of life (HrQoL) after hip fracture.
  
  
  METHODS
  A total of 402 patients with a mean age of 81 years suffering from a hip fracture were included in this prospective, observational cohort study. HrQoL (determined by the EuroQol instrument) was measured at admission and at discharge from an acute care hospital. Independent factors correlated with HrQoL at discharge and changes from pre-fracture to discharge were determined using multivariate analyses. The influence of antidepressants was evaluated by an ANOVA with repeated measurements.
  
  
  RESULTS
  Need of care prior to fracture was the most important determinant of EQ-5D index at discharge (ß = -0.359, p = 0.003). Additionally, low Mini Mental Status Examination (MMSE) was associated with a lower EQ-5D index at discharge (MMSE 0-9: ß = -0.238, p <0.001; MMSE 10-19: ß = -0.294, p <0.001) and a greater decrease in EQ-5D during hospitalisation (MMSE 10-19: ß = 0.281, p <0.001), while joint replacement (compared to internal fixation) was associated with a higher EQ-5D index (ß = 0.188, p = 0.002) and a lower decrease in the index (ß = -0.216, p = 0.003). EQ VAS values at discharge were correlated with pre-fracture Barthel Index (ß = 0.253, p <0.001) and Geriatric Depression Scale scores (ß = -0.135, p = 0.026). Depressive patients on antidepressants demonstrated less of a decrease in the EQ-5D index compared to patients not receiving medication (F = 2.907, p = 0.090).
  
  
  CONCLUSIONS
  Acute care of hip fracture patients should be focused on functional recovery and treatment of depression. When the preferred surgical strategy is unclear, joint replacement should be considered.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Giessen and Marburg GmbH, Baldingerstrasse, 35043, Marburg, Germany, buecking@med.uni-marburg.de.
authors.forename: B
authors.initials: B
authors.lastname: Buecking
authors.forename: J
authors.initials: J
authors.lastname: Struewer
authors.forename: A
authors.initials: A
authors.lastname: Waldermann
authors.forename: K
authors.initials: K
authors.lastname: Horstmann
authors.forename: N
authors.initials: N
authors.lastname: Schubert
authors.forename: M
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.forename: R
authors.initials: R
authors.lastname: Dodel
authors.forename: K
authors.initials: K
authors.lastname: Bohl
authors.forename: S
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: C
authors.initials: C
authors.lastname: Bliemel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000534:rehabilitation; D003863:Depression / Q000150:complications / Q000188:drug therapy; D005260:Female; D005593:Fracture Fixation, Internal / Q000534:rehabilitation; D006305:Health Status Indicators; D006620:Hip Fractures / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000150:complications / Q000534:rehabilitation* / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life
chemical_list: D000928:Antidepressive Agents