title: Wrist fractures and their impact in daily living functionality on elderly people: a prospective cohort study.
abstract: BACKGROUND
  Wrist fractures are the most common arm fractures in older adults. The impact of wrist fractures on daily functionality has been less studied than that of other types and so, less is known about the complexity of factors related to the functional impact of these fractures. This study is aimed to assess the role of individual and health care factors and its association with daily living functional changes after a wrist fracture.
  
  
  METHODS
  A prospective cohort of patients aged 65 or more, affected by a fracture due to a fall, was conducted. These patients were identified at the emergency rooms of the six participating hospitals. As independent factors, the following were studied: socio-demographic data, characteristics of the fracture, health-related quality of life, wrist function and provided treatment. The main outcome was functional status measured by the Barthel Index for daily living basic activities and the Lawton Instrumental Activities of Daily Living (IADL) Scale for daily living instrumental activities. Data were collected at baseline just after the fall and after six months of follow-up. Patients were considered to have deteriorated if their functional status as measured by Barthel Index or Lawton IADL scores decreased in a significant way during the six months of follow up.
  
  
  RESULTS
  Barthel Index and/or Lawton IADL scores fell at six months after the fracture in 33% of participants. This functional decline was more frequent in patients with comorbidity (p < 0.0001), polypharmacy (p < 0.0001), low health-related quality of life prior to the fall (p < 0.0001) and lower educational level (p = 0.009). The derived multivariate models show that patients that become dependent six months after the fall, have advanced age, severe chronic diseases, low functional performance prior to the fracture, and repeated episodes of accidental falls. This profile is consistent with a frailty phenotype.
  
  
  CONCLUSIONS
  Wrist fractures are associated to the occurrence of dependence, especially in frail patients. These patients could benefit from being identified at the time the fracture is treated, in order to tackle their complex needs and so, prevent some of the burden of dependence generated by these fractures.
authors.affiliation: Unidad de investigacion AP-OSIS Gipuzkoa, Osakidetza, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Instituto de Investigación Sanitaria Biodonostia, San Sebastian-Donostia, Spain. itziar.vergaramitxeltorena@osakidetza.net.
authors.forename: Itziar
authors.initials: I
authors.lastname: Vergara
authors.affiliation: Unidad de investigacion AP-OSIS Gipuzkoa, Osakidetza, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Instituto de Investigación Sanitaria Biodonostia, San Sebastian-Donostia, Spain. kalliopi.vrotsoukanari@osakidetza.net.
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Vrotsou
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain. miren.orivecalzada@osakidetza.net.
authors.forename: Miren
authors.initials: M
authors.lastname: Orive
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain. susana.garciagutierrez@osakidetza.net.
authors.forename: Susana
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain. nerea.gonzalezhernandez@osakidetza.net.
authors.forename: Nerea
authors.initials: N
authors.lastname: Gonzalez
authors.affiliation: Psychology Department of Personality, Assessment and Treatment, University of Deusto, Bilbao, Bizkaia, Spain. carlota.lashayas@deusto.es.|Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain. carlota.lashayas@deusto.es.
authors.forename: Carlota
authors.initials: C
authors.lastname: Las Hayas
authors.affiliation: Unidad de Investigación, Hospital Galdakao-Usansolo, Red de Investigación en Servicios Sanitarios y Enfermedades Crónicas (REDISSEC), Galdakao, Bizkaia, Spain. josemaria.quintanalopez@osakidetza.net.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Quintana
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation; D015577:Geriatric Assessment / Q000379:methods; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D020380:Needs Assessment; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014954:Wrist Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000534:rehabilitation