title: Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures.
abstract: OBJECTIVE
  To examine the influence of cognitive impairment on the functional outcomes and complication rates of patients with hip fracture during in-patient treatment.
  
  
  METHODS
  A total of 402 patients who were surgically treated for hip fractures were consecutively enrolled at a single trauma center. The patients were grouped according to their results on the Mini-Mental State Examination (MMSE), i.e., ≥20 points (group I) and ≤19 points (group II). Complication and in-hospital mortality rates as well as postoperative functional outcomes according to the Barthel Index (BI) were compared between the groups. A multivariate regression analysis was performed to control for additional factors.
  
  
  RESULTS
  33% of the patients had MMSE scores ≤19 points. The complication rates were similar between the groups (p > 0.05). Likewise, the overall in-hospital mortality rates were similar between the patients in group I (4.5%) and those in group II (9.8%; β = 0.218, p < 0.740). Functional outcomes, as assessed by the BI, were lower in group II (β = -0.266, p < 0.001). The patients in group II were transferred to a rehabilitation clinic less frequently (52.3 vs. 76.0%, p < 0.001).
  
  
  CONCLUSIONS
  Patients with lower MMSE scores are at a higher risk for poorer functional outcomes. Perioperative care should focus on the preservation of functional abilities to protect these patients from an additional loss of independence and disadvantageous clinical course.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg, Marburg, Germany.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bliemel
authors.forename: Philipp
authors.initials: P
authors.lastname: Lechler
authors.forename: Ludwig
authors.initials: L
authors.lastname: Oberkircher
authors.forename: Christian
authors.initials: C
authors.lastname: Colcuc
authors.forename: Monika
authors.initials: M
authors.lastname: Balzer-Geldsetzer
authors.forename: Richard
authors.initials: R
authors.lastname: Dodel
authors.forename: Steffen
authors.initials: S
authors.lastname: Ruchholtz
authors.forename: Benjamin
authors.initials: B
authors.lastname: Buecking
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis / Q000534:rehabilitation; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000401:mortality / Q000534:rehabilitation / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010351:Patient Discharge; D011446:Prospective Studies; D012307:Risk Factors; D016896:Treatment Outcome