Increase in Disability Prevalence Before Hip Fracture.
OBJECTIVE
To establish the prevalence and correlates of disability during the 2 years before hip fracture.


METHODS
Data from participants who experienced hip fracture in the Health and Retirement Study (HRS) with hip fracture identified using linked Medicare claims. Each participant was interviewed at varying time points in the 2 years before hip fracture. Disability was defined as self-report of the need for assistance in any activity of daily living (walking across the room, eating, bathing, dressing, using the toilet, transferring). Based on the timing between interview and hip fracture, prevalence of disability was calculated in the cohort as a whole over the 2 years before hip fracture and in subgroups defined according to demographic and clinical characteristics.


METHODS
The HRS is a nationally representative longitudinal study (1992-2010).


METHODS
HRS participants aged ≥65 with hip fracture (mean age at fracture 84, 77% female).


RESULTS
The adjusted prevalence of disability was 20% (95% confidence interval (CI) = 14-25%) 2 years before hip fracture, with little change until approximately 10 months before fracture, when it started to rise, reaching 44% (95% CI = 33-55%) in the month before hip fracture. The prevalence of disability was highest in the last month before fracture for persons aged 85 and older (53%) and for those with dementia (60%).


CONCLUSIONS
Care models for hip fracture need to consider not only the acute medical and surgical needs, but also the high level of need for supportive care and caregiver assistance that chronically disabled individuals require.
Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.|Veterans Affairs Medical Center, San Francisco, California.
Alexander K
AK
Smith
Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.|Veterans Affairs Medical Center, San Francisco, California.
Irena Stijacic
IS
Cenzer
Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.|Veterans Affairs Medical Center, San Francisco, California.|Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California.
W
W
John Boscardin
Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.
Christine S
CS
Ritchie
Department of Physiological Nursing, University of California at San Francisco, San Francisco, California.|Department of Jewish Home of San Francisco Center for Research on Aging, San Francisco, California.
Margaret L
ML
Wallhagen
Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California.|Veterans Affairs Medical Center, San Francisco, California.
Kenneth E
KE
Covinsky
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003704:Dementia / Q000453:epidemiology; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D006306:Health Surveys; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D007182:Income; D008297:Male; D051346:Mobility Limitation; D015995:Prevalence; D014481:United States / Q000453:epidemiology
disability; epidemiology; hip fracture