Psychocognitive Factors and Recovery from Hip Fracture : A Real-life Prospective Cohort Study

The data for this study comprised hip fracture patients aged 65 years or more suffering their first hip fracture and treated in Seinäjoki Central Hospital between 2007 and 2019 (n=2,320). Data were collected on admission, during hospital care, in an outpatient comprehensive geriatric assessment (CGA) 4–6 months post-hip fracture and by telephone interviews after the index fracture. New diagnosed cognitive disorder extracted manually from the electronic patient files was documented in almost one in four patients (23.3%). Cognitive disorders had usually advanced to a moderate to severe stage before diagnosis. Higher age, multiple comorbidities and malnutrition were associated with new cognitive disorders. The array of diagnoses did not differ from general occurrence as Alzheimer’s disease with or without vascular cognitive impairment was the most common diagnosis. Delirium during acute hospital care was a significant predictor of an imminent diagnosis of a cognitive disorder. Depressive mood assessed at the outpatient clinic was associated with poorer physical and cognitive performance, and also with malnutrition. Depressive mood was seldom severe. Fear of falling (FoF) was more common in female patients and in patients with multiple medications in regular use and moreover associated with poorer physical performance. Patients with pre-fracture cognitive disorders reported less FoF than those without. Neither depressive mood nor FoF explained the decreased mobility level, change to more supported living arrangements or mortality in one-year follow-up. Previously undiagnosed cognitive disorders are common in older hip fracture patients. Delirium during hospital care is associated with development of subsequent new diagnoses of cognitive disorders. Depressive mood and FoF are common multifactorial conditions which deserve attention during recovery but do not explain the changes in outcomes one year after the hip fracture. There seems to be significant overlap and co-occurrence of psychocognitive factors in this remarkably heterogeneous population, and thus, CGA should be considered as a standardized protocol throughout the post-hip fracture pathway.Tutkimuksen tavoitteena oli tutkia lonkkamurtuman jälkeisessä seurannassa todettavia uusia muistisairauksia sekä muiden psykokognitiivisten tekijöiden merkitystä sairaalahoidon ja toipumisen aikana. Aineisto koostui Seinäjoen keskussairaalassa vuosina 2007–2019 hoidetuista yli 65-vuotiaista lonkkamurtumapotilaista (n=2320). Tiedot kerättiin sairaalahoidon aikana, polikliinisessä kokonaisvaltaisessa geriatrisessa arvioinnissa (CGA) 4–6 kuukautta murtuman jälkeen, sekä puhelinhaastatteluilla. Muistisairauteen sairastuminen oli yleistä toipumisen aikana. Sairauden vaihe oli yleensä ehtinyt edetä kohtalaiseen tai vakavaan vaikeusasteeseen ennen diagnoosia. Uutta muistisairautta ennusti korkeampi ikä, komorbiditeetit ja vajaaravitsemus. Todettujen muistisairausdiagnoosien kirjo ei poikennut yleisistä esiintyvyyksistä. Sairaalahoidon aikainen delirium oli selvästi yhteydessä uuteen muistisairauteen. Depressiivistä mielialaa todettiin lähes joka kolmannella ja kaatumisen pelkoa lähes joka toisella potilaalla lonkkamurtuman jälkeisessä CGA:ssa. Depressiivinen mieliala oli yhteydessä huonompaan toiminnalliseen, fyysiseen ja kognitiiviseen suorituskykyyn, sekä vajaaravitsemukseen. Vaikeusasteeltaan depressiivinen mieliala oli harvoin vakavaa. Kaatumisen pelko oli yleisempää naisilla ja monilääkityillä. Kaatumisen pelko liittyi myös heikompaan fyysiseen suorituskykyyn. Potilaat, joilla oli todettu muistisairaus ennen lonkkamurtumaa, kokivat vähemmän kaatumisen pelkoa, kuin potilaat, joilla ei ollut todettua muistisairautta. Depressiivinen mieliala tai kaatumisenpelko eivät yksinään selittäneet heikentynyttä liikuntakykyä, muuttoa tuetumpaan asumismuotoon tai kuolleisuutta vuoden kuluttua murtumasta. Aiemmin diagnosoimattomat muistisairaudet ovat yleisiä iäkkäillä lonkkamurtumapotilailla. Sairaalahoidon aikainen delirium on yhteydessä uusiin lonkkamurtuman jälkeen todettuihin muistisairauksiin. Depressiivinen mieliala ja kaatumisen pelko ovat yleisiä, monitekijäisiä ongelmia, jotka on syytä huomioida kuntoutumisen aikana, mutta eivät yksinään selitä tilannetta vuoden kuluttua murtumasta. Psykokognitiiviset tekijät voivat esiintyvät limittäin tai samanaikaisesti tässä hauraassa potilasryhmässä ja siksi lonkkamurtuman jälkeinen CGA olisi tärkeää saada osaksi standardoitua hoitopolkua

Combining diagnostic memory clinic with rehabilitation follow-up after hip fracture

Purpose: Cognitive impairment and dementia are common in older hip fracture patients. We describe new diagnoses of cognitive disorders (NDCDs) and associated factors in a two-year post-hip fracture follow-up including the use of the diagnostic facilities of a memory clinic.Methods: Data were collected on admission and at outpatient assessment 4–6 months post-hip fracture. Diagnoses of cognitive disorders followed the evidence-based Finnish national care guideline including internationally accepted criteria. NDCDs up to 2 years post-hip fracture were extracted manually from the patient files. Logistic regression models were computed to examine the associations between the pre-fracture factors and the domains of the outpatient geriatric assessment and NDCDs.Results: Of the 1165 hip fracture patients aged ≥ 65 years, 831 had no previous diagnosis of cognitive disorder. Of these, NDCD was documented in 23.3%. Alzheimer’s disease (AD) with or without vascular cognitive impairment (VCI) was the most common diagnosis. Cognitive disorder was usually at a moderate stage. Age, higher ASA score and poor nutritional status on admission were associated with new cognitive disorders. At the outpatient follow-up, poorer activities of daily living and mobility disability were associated with NDCD. Patients with a NDCD were more likely to suffer greater mobility impairment, poorer nutritional status and to have more supported living arrangements at follow-up than in the pre-fracture situation.Conclusion: NDCDs are common after hip fracture and associated with impaired rehabilitation outcomes and poor nutritional status. A post-hip fracture assessment co-organized in the form of a memory clinic seems to be feasible to detect previously undiagnosed cognitive disorders. Earlier diagnosis of cognitive disorders is warranted.</p

Factors associated with and 1-year outcomes of fear of falling in a geriatric post-hip fracture assessment

Background: Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences. Objective: To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF. Methods: An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4–6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality. Results: Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating ≥ 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes. Conclusion: Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.publishedVersionPeer reviewe

Factors associated with and 1-year outcomes of fear of falling in a geriatric post-hip fracture assessment

Background Hip fracture causes not only physical injury but also psychological trauma. Fear of falling (FoF) is related to poor recovery, loss of mobility and mortality. There is limited data on the clinical factors affecting post-hip fracture FoF and its consequences. Objective To investigate the factors associated with and 1-year outcomes of post-hip fracture FoF. Methods An observational prospective cohort study. Data were collected on hospital admission, at a geriatric outpatient assessment 4-6 months post-hip fracture and by telephone interviews 1 year after the index fracture. FoF was assessed with a dichotomous single-item question. Logistic regression analyses were conducted to examine the age, gender and multivariable-adjusted association between baseline and the geriatric assessment domains with FoF. Follow-up outcomes included changes in mobility, living arrangements and mortality. Results Of the 916 patients included, 425 (49%) had FoF at the time of their geriatric assessment. These patients were predominantly female and were living alone in their own homes with supportive home care. They scored lower on tests of physical performance. Less FoF was documented in patients with diagnosed cognitive disorders before the index fracture and in those with Clinical Dementia Rating >= 1. After adjusting for age and gender, no association was observed between FoF and any of the 1-year follow-up outcomes. Conclusion Post-hip fracture FoF is common and associated with female gender, polypharmacy, poor daily functioning, poor physical performance and depressive mood. Patients with cognitive disorders have less FoF than those without. FoF appears to have no impact on the follow-up outcomes.</p

Prevalence and prognostic significance of depressive symptoms in a geriatric post-hip fracture assessment

Objectives: To investigate the prevalence and prognostic significance of post-hip fracture depressive symptoms.Methods: A naturalistic clinical cohort study. Data were collected on admission to hospital, geriatric assessment 4-6 months post-fracture and by telephone interview one-year post fracture. Depressive symptoms were assessed at the geriatric assessment using the 15-item Geriatric Depression Scale (GDS-15). Logistic regression analyses with multivariable models were conducted to examine the association of depressive symptoms with changes in mobility and living arrangements and Cox proportional hazards models for mortality between the geriatric assessment and one-year follow-up.Results: Of the 1070 patients, 22% (n = 238) had mild and 6% (n = 67) moderate to severe depressive symptoms. Patients with depressive symptoms had poorer nutritional status at baseline, lower scores on the cognitive and physical performance tests and poorer functional abilities in the geriatric assessment than those without. No association was observed between depressive symptoms and any of the outcomes at one-year follow-up. Poor nutritional status and physical functioning remained significant prognostic indicators.Conclusion: Post-hip fracture depressive symptoms are common and deserve attention during post-hip fracture recovery and rehabilitation. Nonetheless, depressive symptoms have no impact on the change in mobility or living arrangements or mortality. These latter outcomes are mainly explained by poor nutritional status and functioning.</p

Prevalence and prognostic significance of depressive symptoms in a geriatric post-hip fracture assessment

Objectives: To investigate the prevalence and prognostic significance of post-hip fracture depressive symptoms. Methods: A naturalistic clinical cohort study. Data were collected on admission to hospital, geriatric assessment 4–6 months post-fracture and by telephone interview one-year post fracture. Depressive symptoms were assessed at the geriatric assessment using the 15-item Geriatric Depression Scale (GDS-15). Logistic regression analyses with multivariable models were conducted to examine the association of depressive symptoms with changes in mobility and living arrangements and Cox proportional hazards models for mortality between the geriatric assessment and one-year follow-up. Results: Of the 1070 patients, 22% (n = 238) had mild and 6% (n = 67) moderate to severe depressive symptoms. Patients with depressive symptoms had poorer nutritional status at baseline, lower scores on the cognitive and physical performance tests and poorer functional abilities in the geriatric assessment than those without. No association was observed between depressive symptoms and any of the outcomes at one-year follow-up. Poor nutritional status and physical functioning remained significant prognostic indicators. Conclusion: Post-hip fracture depressive symptoms are common and deserve attention during post-hip fracture recovery and rehabilitation. Nonetheless, depressive symptoms have no impact on the change in mobility or living arrangements or mortality. These latter outcomes are mainly explained by poor nutritional status and functioning.publishedVersionPeer reviewe