Residual Disability, Mortality, and Nursing Home Placement after Hip Fracture over Two Decades

Publication date: Available online 2 November 2018

Source: Archives of Physical Medicine and Rehabilitation

Author(s): Danielle S. Abraham, Erik Barr, Glenn V. Ostir, J. Richard Hebel, Justine Golden, Ann L. Gruber-Baldini, Jack M. Guralnik, Marc C. Hochberg, Denise L. Orwig, Barbara Resnick, Jay S. Magaziner

ABSTRACT

Objective

To examine trends in 12-month post-fracture residual disability, nursing home placement, and mortality among patients with a hip fracture between 1990 and 2011.

Design

Secondary analysis of 12-month outcomes from three cohort studies and control arms of two randomized controlled trials.

Setting

Original studies were conducted as part of the Baltimore Hip Studies (BHS).

Participants

Community-dwelling patients ≥65 years of age hospitalized for surgical repair of a non-pathological hip fracture (n=988).

Main Outcomes

12-month residual disability, mortality, and nursing home residency were examined in case-mix adjusted models by sex and study. Residual disability was calculated by subtracting pre-fracture scores of Lower Extremity Physical Activities of Daily Living from scores at 12-months post fracture. We also examined the proportion of individuals with a 12-month score higher than their pre-fracture score (residual disability >0).

Results

Only small improvements were seen in residual disability between 1990 and 2011. No significant differences were seen for men between BHS2 (enrollment 1990-1991; mean residual disability=3.1 activities, 95% CI: 2.16, 4.10) and BHS7 (enrollment 2006-2011; mean=3.1 activities, 95% CI: 2.41, 3.82). In women, residual disability significantly improved from BHS2 (mean=3.5 activities, 95% CI: 2.95, 3.99) to BHS3 (enrollment 1992-1995; mean=2.7 activities, 95% CI: 2.01, 3.30) with no significant improvements in later studies. After adjustment, a substantial proportion (91% of men and 79% of women) had a negative outcome (residual disability, died, or nursing home residence at 12 months) in the most recently completed study (BHS7).

Conclusions

Over two decades, patients undergoing usual care post-hip fracture still had substantial residual disability. Additional clinical and research efforts are needed to determine how to improve hip fracture treatment, rehabilitation, and subsequent outcomes.

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