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Rates of Recovery to Pre-Fracture Function in Older Persons with Hip Fracture: an Observational Study.


Tang, V., Sudore, R. L., Cenzer, I. S., Boscardin, W. J., Smith, A., Ritchie, C. S., . . . Covinsky, K. E.


Journal of General Internal Medicine




Background: Knowledge about expected recovery after hip fracture is essential to help patients and families set realistic expectations and plan for the future.

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

Design: Observational study.

Participants: 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.Main

Measures: 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.

Key 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.


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