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- Title
Cognitive Status at Hospital Admission: Postoperative Trajectory of Functional Recovery for Hip Fracture.
- Authors
Jones, C. Allyson; Jhangri, Gian S.; Feeny, David H.; Beaupre, Lauren A.
- Abstract
<bold>Background: </bold>Cognitive impairment is common in the hip fracture patient population, yet few studies of functional recovery include this subgroup. The objective was to determine whether baseline cognition was a determinant of the rate of functional recovery over 6 months after hip fracture.<bold>Methods: </bold>A consecutive cohort of 383 patients 65 years or older who were treated for hip fracture within a Canadian health region were grouped on cognitive status. Participants with Mini-Mental Status Examination scores <18 at 3-5 days postoperatively were classified as cognitively impaired. Primary outcome was the Functional Independence Measure. Interviews were completed within 5 days postoperatively (baseline), 1, 3, and 6 months postoperatively. Linear mixed modeling examined the pattern of recovery and the effect of cognitive status.<bold>Results: </bold>Of the 383 participants, 104 (27%) had Mini-Mental Status Examination scores of less than 18. The effect size for changes in the FIM over 6 months was large for those without cognitive impairment (effect size = 2.3) and smaller for those with cognitive impairment (effect size = 0.9). After adjusting for age, gender, proxy respondent, and fracture type, participants with impaired cognition recovered more slowly, never attaining comparable levels with those without cognitive impairment. The 6-month health status for the cohort was substantially lower than the health status of age-gender-matched, community-dwelling adults.<bold>Conclusions: </bold>Patients with cognitive impairment who fracture their hips recover more slowly and achieve less functional recovery. Recovery is not uniform nor is it linear over the initial 6 months. The diversity of patient needs should be recognized postoperatively so that long-term recovery is optimized.
- Subjects
CANADA; COGNITIVE ability; HOSPITAL admission &; discharge; HEALING; HIP fractures; FRACTURE fixation; COGNITION; HEALTH outcome assessment; THERAPEUTICS; TREATMENT of fractures; BONE fractures -- Psychological aspects; CONVALESCENCE; BONE fractures; HEALTH status indicators; HOSPITAL care; HIP joint injuries; LONGITUDINAL method; TIME; PSYCHOLOGY
- Publication
Journals of Gerontology Series A: Biological Sciences & Medical Sciences, 2017, Vol 72, Issue 1, p61
- ISSN
1079-5006
- Publication type
journal article
- DOI
10.1093/gerona/glv138