title: Factors associated with short-term functional recovery in elderly people with a hip fracture. Influence of cognitive impairment.
abstract: OBJECTIVE
  To assess factors associated with functional recovery and determine the influence of cognitive impairment.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Orthogeriatric rehabilitation ward.
  
  
  METHODS
  A total of 314 older adults (≥65 years) admitted for rehabilitation after a hip operation.
  
  
  METHODS
  Patients were stratified according to the Mini Mental State Examination into the following categories: severe cognitive impairment, scores 0 to 15; mild cognitive impairment, scores 16 to 23; and no cognitive impairment, scores ≥24. Their functional status, in terms of activities of daily living (ADLs), was recorded, and their ability to walk was measured with the Functional Ambulation Categories at 3 points in time: basal, on admission, and on discharge. We considered recovery of ADLs and ability to walk to be positive responses to rehabilitation treatment.
  
  
  RESULTS
  Of the patients included, 285 finished the study (16 patients were moved to another hospital and 13 patients died) and 280 received rehabilitation treatment, with all 3 groups achieving functional gain (P < .01). Fifty-eight percent of patients recovered both the autonomy in ADLs they had before the fracture and the ability to walk (73.7% without cognitive impairment, 50% mild cognitive impairment, and 5% severe cognitive impairment) (P < .001). Previous walking ability (odds ratio [OR] 5.57, 95% confidence interval [CI] 2.41-12.74) together with the presence of pressure ulcers (OR 11.12, 95% CI 2.88-43.29) and delirium (OR 3.20, 95% CI 1.07-9.52) are sturdier predictive factors for functional recovery than the degree of cognitive impairment (OR 1.12, 95% CI 1.04-1.22).
  
  
  CONCLUSIONS
  Previous walking ability and the presence of complications, such as pressure ulcers or delirium, play a greater role in functional recovery than cognitive impairment. Not considering these aspects could lead to an overestimation of the impact of cognitive impairment in the recovery of these patients.
authors.affiliation: Department of Geriatrics, Hospital San Juan de Dios, Pamplona, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Uriz-Otano
authors.affiliation: Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain.
authors.forename: Juan Isidro
authors.initials: JI
authors.lastname: Uriz-Otano
authors.affiliation: Department of Geriatrics, Hospital San Juan de Dios, Pamplona, Spain. Electronic address: vmalafarina@gmail.com.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Malafarina
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000534:rehabilitation*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006620:Hip Fractures / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D012047:Rehabilitation Centers; D018570:Risk Assessment; D012720:Severity of Illness Index; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
keywords: Hip fracture; activities of daily living; cognitive impairment; functional recovery; older people