What are the influencing factors in self-rated health status after hip fracture? A prospective study on 402 patients

Health-related quality of life and associated factors after hip fracture. Results from a six-month prospective cohort study

Background

Hip fractures are a major public health problem with increasing relevance in aging societies. They are associated with high mortality rates, morbidity, and loss of independence. The aim of the EMAAge study was to determine the impact of hip fractures on patient-reported health-related quality of life (HRQOL), and to identify potential risk factors for worse outcomes.

Methods

EMAAge is a multicenter, prospective cohort study of patients who suffered a hip fracture. Patients or, if necessary, proxies were interviewed after initial treatment and after six months using standardized questionnaires including the EQ-5D-5L instrument, the Oxford Hip Score, the PHQ-4, the Short Nutritional Assessment Questionnaire, and items on patients living situation. Medical data on diagnoses, comorbidities, medications, and hospital care were derived from hospital information systems.

Results

A total of 326 patients were included. EQ-5D index values decreased from a mean of 0.70 at baseline to 0.63 at six months. The mean self-rated health on the EQ-VAS decreased from 69.9 to 59.4. Multivariable linear regression models revealed three relevant associated factors with the six-months EQ-5D index: symptoms of depression and anxiety, pre-fracture limitations in activities of daily living, and no referral to a rehabilitation facility had a negative impact. In addition, the six-months EQ-VAS was negatively associated with polypharmacy, living in a facility, and migration background.

Conclusions

Hip fractures have a substantial negative impact on patients HRQOL. Our results suggest that there are modifying factors that need further investigation including polypharmacy and migration background. Structured and timely rehabilitation seems to be a protective factor.

Self-rated health status and activities of daily living in the first 12 months after fragility fractures of the pelvis-a prospective study on 134 patients

The aim of this study was to evaluate changes in activities of daily living and self-reported health status in the first year after fragility fractures of the pelvis. We found out that these fractures lead to a significant, long-lasting deterioration of both parameters, comparable with hip fractures.

PURPOSE

The aim of this prospective study was to evaluate the development and to identify influencing factors in activities of daily living (ADL) and self-reported health status (HS) in the first year after fragility fractures of the pelvis (FFP).

METHODS

A total of 134 patients with FFP ≥ 60 years were included. ADL were measured using the Barthel index (BI) and the IADL scale pre-fracture, at 6 weeks, 6 months, and 12 months. HS was evaluated using the EQ-5D questionnaire at 6 weeks, 6 months, and 12 months. Multiple regression analysis and hierarchical linear models were applied to identify influencing factors in ADL and HS.

RESULTS

The BI was 95 pre-fracture, 75 at 6 weeks (p < 0.001), 80 at 6 months (p = 0.178), and 80 at 12 months (p = 0.149). The IADL was 6 pre-fracture, 3 at 6 weeks (p < 0.001), 4 at 6 months (p = 0.004), and 4 at 12 months (p = 0.711). The EQ-5D index was 0.70 at 6 weeks, 0.788 at 6 months (p = 0.158), and 0.788 at 12 months (p = 0.798). Significant influencing factors in the multiple regression analysis were pre-fracture nursing care level for all scores; pre-fracture mobility for BI; and pre-fracture IADL, ASA score, and age for IADL. Significant influencing factors in the hierarchical linear model were pre-fracture nursing care level for all scores; pre-fracture IADL, ASA score, age, and time for IADL; and pre-fracture mobility, sex, and time for the EQ-5D.

CONCLUSION

Our results confirm that FFP lead to a significant, long-lasting deterioration in ADL and HS, comparable with hip fractures.

Rehabilitation Concerns in the Geriatric Critically Ill and Injured - Part 2

As life expectancy increases and birth rates decline, the geriatric population continues to grow faster than any other age group. Aging is characterized by a progressive physiologic decline that promotes the onset of functional limitation and disability. With the increasing geriatric population, more elderly patients are presenting to emergency departments after trauma, and intensive care units are being met with increasing demand. Rehabilitation is critical in improving quality of life by maximizing physical, cognitive, and psychological recovery from injury or disease.

Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis

Operative treatment of osteoporosis-associated fragility fractures of the pelvis (FFP) and the sacrum is advocated with immobilizing or longstanding pain, fracture progression and displacement. We analyzed clinical outcomes regarding mobility, quality of life, and mortality of patients with FFP treated with trans-sacral bar (TB) osteosynthesis through S1. Demographics, clinical data, and operation-related data of patients with an FFP treated with TB were acquired from chart review. We assessed mortality, quality of life (EQ-5D), mobility, and residential status at follow-up. Seventy-nine females and six males with a median age of 78.0 years (IQR 73–84) were included, median follow-up was 3.2 years. Medical complications during hospitalization occurred in 28%. Operative revision was carried out in 15% of patients. One-year survival was 90.4%, this was associated with shorter preoperative and total length of stay in hospital (p 0.006 and 0.025, respectively). At follow-up, 85% lived at home and 82% walked with or without walking aid. Higher EQ-5D was reached with higher mobility status and living at home (p < 0.001 and < 0.001, respectively). TB osteosynthesis is an adequate and reliable method for fixation of FFP in the posterior pelvic ring to ensure timely mobilization. Shorter preoperative and total length of stay had lower mortality rates, advocating a standardized management protocol to limit time delay to operative therapy. Patients treated with TB osteosynthesis had low 1-year mortality of less than 10%.