title: Does cognitive/physical screening in an outpatient setting predict institutionalization after hip fracture?
abstract: Institutionalization after hip fracture is a socio-economical burden. We examined the predictive value of Instrumental Activities of Daily Living (IADL) and Mini Mental State Examination (MMSE) for institutionalization after hip fracture to identify patients at risk for institutionalization.
  
  
  
  Fragility hip fracture patients ≥65 years of age (n = 584) were comprehensively examined at a geriatric outpatient clinic 4 to 6 months after surgery and followed 1 year postoperatively. A telephone interview with a structured inquiry was performed at 1, 4, and 12 months after hip fracture.
  
  
  
  Age-adjusted univariate logistic regression analysis revealed that IADL and MMSE scores measured at the outpatient clinic were significantly associated with living arrangements 1 year after hip fracture. Multivariate logistic regression analysis established that institutionalization 1 year after hip fracture was significantly predicted by institutionalization at 4 months (odds ratio [OR] 16.26, 95 % confidence interval [CI] 7.37-35.86), IADL <5 (OR 12.96, 95 % CI 1.62-103.9), and MMSE <20 (OR 4.19, 95 % CI 1.82-9.66). A cut-off value of 5 was established for IADL with 100 % (95 % CI 96 %-100 %) sensitivity and 38 % (95 % CI 33 %-43 %) specificity and for MMSE, a cut-off value of 20 had 83 % (95 % CI 74 %-91 %) sensitivity and 65 % (95 % CI 60 %-70 %) specificity for institutionalization. During the time period from 4 to 12 months, 66 (11 %) patients changed living arrangements, and 36 (55 %) of these patients required more supportive accommodations.
  
  
  
  IADL and MMSE scores obtained 4 to 6 months after hospital discharge may be applicable for predicting institutionalization among fragility hip fracture patients ≥65 years of age at 1 year after hip fracture. An IADL score of ≥5 predicted the ability to remain in the community. Changes in living arrangements also often occur after 4 months.
authors: Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland. markus.hongisto@uta.fi.|Department of Musculoskeletal Diseases, Tampere University Hospital, Teiskontie 35, Tampere, 33521, Finland. markus.hongisto@uta.fi.
authors: Markus T
authors: MT
authors: Hongisto
authors: Department of Geriatric Medicine, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland.
authors: Maria
authors: M
authors: Nuotio
authors: Science Center, Pirkanmaa Hospital District, Biokatu 6, Tampere, 33520, Finland.|School of Health Sciences, University of Tampere, Terveystieteiden yksikkö, 33014, Tampereen yliopisto, Finland.
authors: Tiina
authors: T
authors: Luukkaala
authors: Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland.
authors: Olli
authors: O
authors: Väistö
authors: Department of Orthopedics and Traumatology, Seinäjoki Central Hospital, Hanneksenrinne 7, Seinäjoki, 60220, Finland.|University of Tampere, Koskenalantie 16, Seinäjoki, Finland.
authors: Harri K
authors: HK
authors: Pihlajamäki
mesh_terms: D000058:Accidental Falls; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D003071:Cognition; D003191:Comprehensive Health Care / Q000379:methods*; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006299:Health Services for the Aged; D006620:Hip Fractures / Q000191:economics / Q000628:therapy*; D006707:Homes for the Aged; D006801:Humans; D007326:Institutionalization; D008297:Male; D009483:Neuropsychological Tests; D010808:Physical Examination; D011446:Prospective Studies; D012307:Risk Factors
keywords: Hip fracture; IADL; Institutionalization; Living arrangements; MMSE; Rehabilitation