School of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
Rejuvenation Res. 2012 Oct;15(5):476-82. doi: 10.1089/rej.2011.1308. Epub 2012 Sep 21.
Hip fracture tremendously impacts functional abilities for the elderly with high morbidity and mortality; recovery is compromised by co-morbidities. Diabetes mellitus is a common co-morbidity for the aging population, but little is known about the influence of diabetes on outcomes of the Asian elderly with hip fracture.
This study was a secondary analysis of data on 242 community-dwelling elders with hip fracture from three previous longitudinal studies. Sixty-one cases (25.2%) had diabetes. Outcomes were measured by the Chinese Barthel Index, Medical Outcomes Study Short Form-36 Taiwan version, and analyzed by the generalized estimating equation approach to examine how diabetes influenced hip-fractured elders' mortality, service utilization, mobility, daily activities, and health-related quality of life during the first 12 months after postsurgical discharge in Taiwan.
Hip-fractured elderly with diabetes had a significantly higher mortality rate (22.6% vs. 10.3%, p=0.03) during the first year following discharge, and significantly higher readmission rate (10.0% vs. 2.5%, p=0.04) from the first to third month following discharge than those without diabetes. After controlling for covariates, elderly participants without diabetes had an overall 2.2 times (confidence interval [CI]=1.15-4.21) greater odds of recovery in walking ability and better reported general health (β=9.33; p=0.01) and physical functioning (β=7.26; p=0.02) than those with diabetes during the first year after discharge.
Diabetes negatively influenced outcomes of elderly patients with hip fracture. The results may provide a reference for developing interventions for hip-fractured elders with diabetes.
髋部骨折极大地影响了老年人的功能能力，其发病率和死亡率都很高；合并症使康复变得复杂。糖尿病是老年人群的常见合并症，但对于亚洲髋部骨折老年患者，糖尿病对其结果的影响知之甚少。
本研究是对来自三项先前纵向研究的 242 名社区居住的髋部骨折老年人数据的二次分析。61 例（25.2%）患有糖尿病。使用中文 Barthel 指数、医疗结局研究简表-36 台湾版来衡量结果，并采用广义估计方程方法进行分析，以检验糖尿病如何影响髋部骨折老年人在手术后出院后 12 个月内的死亡率、服务利用、活动能力、日常活动和健康相关生活质量。
在出院后第一年，患有糖尿病的髋部骨折老年人死亡率（22.6%比 10.3%，p=0.03）显著更高，并且从出院后的第一个月到第三个月的再入院率（10.0%比 2.5%，p=0.04）也显著更高。在控制了协变量后，无糖尿病的老年参与者在行走能力恢复方面总体上有 2.2 倍（置信区间[CI]=1.15-4.21）的更高可能性，并且在报告的总体健康状况（β=9.33；p=0.01）和身体机能（β=7.26；p=0.02）方面也更好，而患有糖尿病的参与者则较差。
糖尿病对髋部骨折老年患者的结果产生负面影响。研究结果可为患有糖尿病的髋部骨折老年人制定干预措施提供参考。
