Centre on Aging and Mobility, University of Zurich and City Hospital Waid, Zurich, Switzerland.
Bone. 2012 Sep;51(3):347-52. doi: 10.1016/j.bone.2012.06.004. Epub 2012 Jun 12.
It is not well established if and to what extent mild to moderate cognitive impairment predicts mortality and risk of nursing home admission after hip fracture.
To investigate prospectively whether and to what extent mild to moderate cognitive impairment, contributes to mortality and admission to nursing home in the first year after acute hip fracture.
We enrolled 173 patients with acute hip fracture age 65 and older who reached a Mini-Mental State Examination (MMSE) score of at least 15 during acute care after hip fracture repair. An MMSE score of 15 to 24 (median) was classified as mild to moderate cognitive impairment. Primary outcomes were mortality in all and admission to nursing home among seniors who lived at home prior to their hip fracture. Follow-up was 12 months with clinical visits at baseline, 6, and 12 months, plus monthly phone calls. We used Cox proportional hazards models controlling for age, sex, body mass index, baseline number of comorbidities and 25-hydroxyvitamin D status, and severe incident infections to assess the risk of mortality and nursing home admission. Because the study population was enrolled in a factorial design clinical trial testing high dose vitamin D and/or an exercise home program, all analyses also controlled for these treatment strategies.
Of 173 acute hip fracture patients enrolled, 79% were women, 77% were admitted from home, and 80% were vitamin D deficient (<20ng/ml). Mean age was 84 years. 54% had mild to moderate cognitive impairment. Over the 12-month follow-up, 20 patients died (27% of 173) and 47 (35% of 134) were newly admitted to a nursing home. Mild to moderate cognitive impairment was associated with a more than 5-fold increased risk of mortality (HR=5.77; 95% CI: 1.55-21.55) and a more than 7-fold increased risk of nursing home admission (HR=7.37; 95% CI: 1.75-30.95). Additional independent risk factors of mortality were male gender (HR=3.55; 95% CI: 1.26-9.97), low BMI (HR=7.25; 95% CI: 1.61-33.74), and baseline 25-hydroxyvitamin D level (per 1ng/ml: HR=0.93; 95% CI: 0.87-0.998; p=0.04).
Mild to moderate cognitive impairment in patients with acute hip fracture is associated with a high risk of mortality and nursing home admission during the first year after hip fracture. Female gender, a greater BMI and a higher 25-hydroxyvitamin D status may protect against mortality after hip fracture independent of cognitive function.
轻度至中度认知障碍是否以及在何种程度上预测髋部骨折后死亡和入住养老院的风险尚未得到充分证实。
前瞻性研究轻度至中度认知障碍是否以及在何种程度上导致髋部骨折后 1 年内死亡和入住养老院。
我们招募了 173 名年龄在 65 岁及以上的急性髋部骨折患者，这些患者在髋部骨折修复后的急性护理期间达到了至少 15 分的简易精神状态检查（MMSE）评分。15 至 24 分（中位数）的 MMSE 评分被归类为轻度至中度认知障碍。主要结局是所有患者的死亡率和髋部骨折前居住在家庭中的老年人入住养老院的比例。随访时间为 12 个月，包括基线、6 个月和 12 个月的临床访视，以及每月的电话随访。我们使用 Cox 比例风险模型来评估死亡率和护理院入院的风险，该模型控制了年龄、性别、体重指数、基线合并症数量和 25-羟维生素 D 状态以及严重的感染事件。由于研究人群被纳入了一项测试高剂量维生素 D 和/或家庭运动计划的因子设计临床试验，因此所有分析还控制了这些治疗策略。
在 173 名急性髋部骨折患者中，79%为女性，77%从家中入院，80%为维生素 D 缺乏症（<20ng/ml）。平均年龄为 84 岁。54%的患者有轻度至中度认知障碍。在 12 个月的随访中，20 名患者死亡（173 名患者中的 27%），47 名（134 名患者中的 35%）新入住养老院。轻度至中度认知障碍与死亡率增加 5 倍以上相关（HR=5.77；95%CI：1.55-21.55），入住养老院的风险增加 7 倍以上（HR=7.37；95%CI：1.75-30.95）。死亡率的其他独立危险因素包括男性（HR=3.55；95%CI：1.26-9.97）、低 BMI（HR=7.25；95%CI：1.61-33.74）和基线 25-羟维生素 D 水平（每 1ng/ml：HR=0.93；95%CI：0.87-0.998；p=0.04）。
急性髋部骨折患者的轻度至中度认知障碍与髋部骨折后 1 年内死亡和入住养老院的风险增加有关。女性、较大的 BMI 和较高的 25-羟维生素 D 状态可能独立于认知功能而降低髋部骨折后的死亡率。
