Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.
BACKGROUND
Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.


OBJECTIVE
To determine rates of functional recovery in older adults who sustained a hip fracture based on one's previous function.


METHODS
Observational study.


METHODS
We identified subjects who sustained a hip fracture while enrolled in the nationally representative Health and Retirement Study (HRS) using linked Medicare claims. HRS interviews subjects every 2 years. Using information from interviews collected during the interview preceding the fracture and the first interview 6 or more months after the fracture, we determined the proportion of subjects who returned to pre-fracture function.


METHODS
Functional outcomes of interest were: (1) ADL dependency, (2) mobility, and (3) stair-climbing ability. We examined baseline characteristics associated with a return to: (1) ADL independence, (2) walking one block, and (3) climbing a flight of stairs.


RESULTS
A total of 733 HRS subjects ≥65 years of age sustained a hip fracture (mean age 84 ± 7 years, 77 % female). Thirty-one percent returned to pre-fracture ADL function, 34 % to pre-fracture mobility function, and 41 % to pre-fracture climbing function. Among those who were ADL independent prior to fracture, 36 % returned to independence, 27 % survived but needed ADL assistance, and 37 % died. Return to ADL independence was less likely for those ≥85 years old (26 % vs. 44 %), with dementia (8 % vs. 39 %), and with a Charlson comorbidity score >2 (23 % vs. 44 %). Results were similar for those able to walk a block and for those able to climb a flight of stairs prior to fracture.


CONCLUSIONS
Recovery rates are low, even among those with higher levels of pre-fracture functional status, and are worse for patients who are older, cognitively impaired, and who have multiple comorbidities.
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA. Victoria.Tang@ucsf.edu.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA. Victoria.Tang@ucsf.edu.|Division of Hospital Medicine, Department of Medicine, Veterans Affairs Medical Center, 181G, 4150 Clement Street, San Francisco, CA, 94121, USA. Victoria.Tang@ucsf.edu.
Victoria L
VL
Tang
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Rebecca
R
Sudore
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Irena Stijacic
IS
Cenzer
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
W John
WJ
Boscardin
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Alex
A
Smith
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Christine
C
Ritchie
Department of Physiological Nursing, School of Nursing, University of California, San Francisco, CA, USA.
Margaret
M
Wallhagen
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Emily
E
Finlayson
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Laura
L
Petrillo
Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.|Division of Geriatrics, Veterans Affairs Medical Center, San Francisco, CA, USA.
Kenneth
K
Covinsky
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003704:Dementia / Q000150:complications; D005260:Female; D015577:Geriatric Assessment; D006620:Hip Fractures / Q000453:epidemiology / Q000534:rehabilitation*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D051346:Mobility Limitation; D020127:Recovery of Function; D016138:Walking
activities of daily living; function; geriatrics; hip fracture; palliative care