From the Department of Geriatric Medicine and Rehabilitation, Shmuel - Harofeh Medical Center, Beer Yaakov (EHM, EL); Department of Geriatric Medicine and Rehabilitation, Sheba Medical Center, Tel-Hashomer (AA); and Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv (EHM, EL, AA), Israel.
Am J Phys Med Rehabil. 2018 Nov;97(11):789-792. doi: 10.1097/PHM.0000000000000969.
The aim of the study was to examine whether a diagnosis of prefracture dementia (PFD) affects functional outcome at discharge from a geriatric rehabilitation setting.
A total of 211 consecutive elderly hip fracture patients were evaluated retrospectively. We used the Functional Independence Measure (FIM) and analyzed data by t test, χ(2) test, and multiple linear regression analysis.
Patients with PFD were older (P = 0.001), presented with lower Mini-Mental State Examination scores (P < 0.001) and lower prefracture function (P < 0.001). Total-FIM and motor-FIM scores at admission and discharge, as well as FIM gain scores at discharge, were lower among patients with PFD, compared with nonprefracture dementia (NPFD) patients (P < 0.001). The FIM daily gains (efficiency) (P < 0.001) and Montebello relative functional scores (P < 0.001) were also lower in PFD, compared with patients with NPFD. However, linear regression analysis showed that PFD did not predict total, motor, or FIM gain at discharge (β = -0.11, P = 0.115; β = -0.06, P = 0.412; β = -0.099, P = 0.329, respectively). Upon discharge, patients with PFD achieved lower FIM scores yet maintained similar motor-FIM gains compared with patients with NPFD.
Our study results supports the inclusion of patients with PFD in postfracture rehabilitation programs.
本研究旨在探讨预发性痴呆（PFD）的诊断是否会影响老年康复机构出院时的功能结局。
回顾性评估了 211 例连续的老年髋部骨折患者。我们使用功能独立性测量（FIM），并通过 t 检验、χ(2)检验和多元线性回归分析进行数据分析。
PFD 患者年龄较大（P = 0.001），表现出较低的简易精神状态检查评分（P < 0.001）和较低的预骨折功能（P < 0.001）。与非预发性痴呆（NPFD）患者相比，PFD 患者入院和出院时的总 FIM 和运动 FIM 评分以及出院时的 FIM 增益评分均较低（P < 0.001）。PFD 患者的 FIM 日常增益（效率）（P < 0.001）和蒙泰贝洛相对功能评分（P < 0.001）也较低。然而，线性回归分析表明，PFD 并未预测出院时的总 FIM、运动 FIM 或 FIM 增益（β = -0.11，P = 0.115；β = -0.06，P = 0.412；β = -0.099，P = 0.329）。出院时，与 NPFD 患者相比，PFD 患者的 FIM 评分较低，但运动 FIM 增益相似。
我们的研究结果支持将 PFD 患者纳入骨折后康复计划。
