Ríos-Germán P P, Menéndez-Colino R, Ramírez Martin R, Alarcón T, Queipo R, Otero Puime A, González-Montalvo J I
Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
Rev Esp Geriatr Gerontol. 2019 Jul-Aug;54(4):207-213. doi: 10.1016/j.regg.2018.12.003. Epub 2019 Feb 22.
To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients.
All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status.
A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001).
Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.
确定养老院（NH）和社区居住（CD）的髋部骨折（HF）患者入院时及骨折后1年的临床和功能差异。
前瞻性纳入2013年1月至2014年2月间在一所大学医院的老年骨科病房收治的所有HF患者。记录入院期间的临床和功能变量以及死亡率。1年后通过电话联系患者以确定其生命状况和功能状态。
共纳入509例患者，其中116例（22.8%）来自养老院。与社区居住患者相比，养老院患者手术风险更高（美国麻醉医师协会身体状况分级≥3级：83.6%对66.4%，P<0.001），理论上的生命预后更差（诺丁汉量表≥5分：98.3%对56.6%，P<0.001），既往功能状态评分更高（Barthel指数中位数：55[四分位间距，36 - 80]对90[四分位间距，75 - 100]，P<0.001），精神状态更差（ Pfeiffer简易精神状态问卷>2分：74.1%对40.2%，P<0.001），肌肉减少症发生率更高（24.3%对15.2%，P<0.05）。住院期间及1年死亡率无差异。1年后，养老院患者恢复至既往行走能力的比例更低（38.5%对56.2%，P<0.001）。
在老年骨科病房接受治疗的HF患者中，养老院患者比社区居住患者手术风险更高，存在功能和精神障碍，肌肉减少症发生率更高。随访1年时，养老院患者死亡率并未更高，但恢复至既往行走能力的频率更低。
