Arinzon Zeev, Fidelman Zeev, Zuta Aneta, Peisakh Alexandr, Berner Yitshal N
Department of Geriatric Medicine, Meir Hospital, 57 Tchernichovski St., Kfar Saba 44281, Israel.
Arch Gerontol Geriatr. 2005 May-Jun;40(3):327-36. doi: 10.1016/j.archger.2004.10.003.
Hip fracture is epidemic and prevalence increased with advanced age. Impact of comorbid and cognitive status, gender, type of fracture, operative delay and pre-fracture ambulatory levels on functional outcome was shown in previous studies. We studied functional outcome after rehabilitation for hip fracture in old-old elderly (85 years and older) and compared it to young elderly (65-74 years) community-dwelling patients. Before the fracture, old-old elderly patients were more functional dependent, has had more comorbid diseases, and more of them live alone than young elderly. The waiting time to surgery and mean length of stay in orthopedic ward were longer than in young elderly. On admission to rehabilitation treatment, old-old patients presented with more depressed mood, were more cognitive impaired, and more suffer from pain. Old-old patients presented with laboratory data of malnutrition (decreased serum levels of albumin, cholesterol, hemoglobin, hematocrit, lymphocyte count) and inflammation (increased of transferrin and C-reactive protein). Improvement in Functional Independence Measurement (FIM) scale was found in both groups but significantly better in young elderly than in old-old elderly. The change in FIM during the rehabilitation period (DeltaFIM) were in FIM total and in those parts of FIM concerning locomotion. The mean duration of rehabilitation stay was significantly longer in old-old elderly patients. On discharge old-old elderly patients more suffer from pain and difference between the groups according to the laboratory and to the cognitive data increased. Age per se is indicator of frailty and determinate functional recovery after hip fracture.
髋部骨折呈流行趋势，患病率随年龄增长而增加。先前的研究表明了合并症和认知状态、性别、骨折类型、手术延迟以及骨折前活动水平对功能结局的影响。我们研究了高龄老年人（85岁及以上）髋部骨折康复后的功能结局，并将其与年轻老年人（65 - 74岁）社区居住患者进行比较。骨折前，高龄老年人功能依赖程度更高，合并疾病更多，且独居者比年轻老年人更多。手术等待时间和骨科病房平均住院时间比年轻老年人更长。在接受康复治疗时，高龄患者情绪更抑郁，认知障碍更严重，疼痛更明显。高龄患者呈现出营养不良（血清白蛋白、胆固醇、血红蛋白、血细胞比容、淋巴细胞计数水平降低）和炎症（转铁蛋白和C反应蛋白升高）的实验室数据。两组患者的功能独立性测量（FIM）量表均有改善，但年轻老年人的改善明显优于高龄老年人。康复期间FIM的变化（DeltaFIM）体现在FIM总分以及FIM中与运动相关的部分。高龄老年人康复住院的平均时间明显更长。出院时，高龄老年人疼痛更明显，两组在实验室数据和认知数据方面的差异增大。年龄本身就是虚弱的指标，并且决定髋部骨折后的功能恢复。
