title: Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture.
abstract: OBJECTIVE
  To identify how the severity of dementia influences functional recovery and mortality in elderly patients hospitalized for hip fracture.
  
  
  METHODS
  An observational retrospective study of 1258 patients aged older than 69 years and diagnosed with hip fracture who received care within an orthogeriatrics unit from 2004 to 2008 was carried out. During a 12-month follow-up period, functional recovery and mortality outcomes were measured.
  
  
  RESULTS
  Dementia was present in 383 (28.1%) patients: it was mild in 183 (48%), moderate in 102 (26.5%) and severe in 98 (25.5%). Compared with patients with preserved cognitive status, patients with dementia had the following statistically significant differences (means [standard deviation] or percentage): older age (preserved, 82.29 years [6.5 years]; mild, 83.63 years [6.1 years]; moderate, 83.47 years [5.9 years]; severe, 84.46 years [6.1 years]; P < 0.001); lower Barthel Index (89.7 [21.6], 72.7 [24.6], 58.9 [28.6], 38.0 [28.1]; P < 0.001); delirium (11.7%, 25.6%, 37.6%, 44.7%; P < 0.001); less ambulation at 6 months postdischarge (83.9%, 72.8%, 56.9%, 41.7%; P < 0.001); and higher mortality at discharge (4%, 5.7%, 8.2%, 10.6%; P < 0.001) and 12 months after discharge (21.2%, 32.3%, 46.3%, 53.5%; P < 0.001). Patients with severe dementia had lower probability of functional recovery at discharge (OR 0.272, 95% CI 0.140-0.526, P < 0.001) and 6 months after discharge (OR 0.439, 95% CI 0.197-0.979, P = 0.04), as well as a greater probability of dying (HR 1.640, 95% CI 1.020-2.635, P = 0.04).
  
  
  CONCLUSIONS
  We observed higher 12-month mortality and less functional recovery with increasing severity of dementia.
authors.affiliation: Department of Geriatrics, Hospital Universitario de la Ribera, Alzira, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Tarazona-Santabalbina
authors.forename: Ángel
authors.initials: Á
authors.lastname: Belenguer-Varea
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rovira Daudi
authors.forename: Enmanuel
authors.initials: E
authors.lastname: Salcedo Mahiques
authors.forename: David
authors.initials: D
authors.lastname: Cuesta Peredó
authors.forename: Juan Ramón
authors.initials: JR
authors.lastname: Doménech-Pascual
authors.forename: Homero
authors.initials: H
authors.lastname: Gac Espínola
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Avellana Zaragoza
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D015897:Comorbidity / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006620:Hip Fractures / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: cognitive impairment; comprehensive geriatric assessment; functional recovery; hip fractures; mortality