University Hospital Essen, Geriatric Centre Haus Berge, Contilia GmbH, Germany.
Department of Neurology, Philipps-University Marburg, Giessen, Germany.
Psychogeriatrics. 2020 Jan;20(1):11-19. doi: 10.1111/psyg.12450. Epub 2019 Mar 28.
Clinical outcomes of patients with proximal femoral fracture within 1 year after hospitalization are presented. In particular, associations between the patients' clinical status and their pre-fracture residence were evaluated (community-dwelling vs nursing home).
Patients aged ≥60 years with proximal femoral fractures were included in a prospective, single-centre observational study and followed for 12 months. Patients' clinical status at baseline was compared to their health status at follow-up 12 months later. Several standardized questionnaires were used to evaluate the patients' functional and cognitive capacity (e.g. Lawton Instrumental Activities of Daily Living Scale, Barthel Index, and Mini-Mental State Examination), mobility (timed up-and-go test, Tinetti Test, and Harris Hip Score), quality of life (EuroQol-5 Dimensions index and EuroQol Visual Analogue Scale), and psychological status (Geriatric Depression Scale).
This study included 402 patients (mean age: 81.3 ± 8.2 years, 72% women). Patients stayed in hospital for 13.7 ± 6.1 days on average. The comparison of patients' clinical status at baseline and at 12-month follow-up revealed that the Mini-Mental State Examination and Charlson Comorbidity Index remained unchanged (P = 0.527 and P = 0.705), the level of depression (Geriatric Depression Scale) significantly decreased (P < 0.001), and quality of life (EuroQol-5 Dimensions index) diminished (P < 0.001). Although patients' mobility increased after 12 months (P < 0.001 for timed up-and-go test and Harris Hip Score), their functional capacity was significantly reduced (P < 0.001 for Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Nursing home residents showed a significantly higher impairment at baseline than community-dwelling individuals and less improvement in functional and cognitive tests at 12-month follow-up.
Clinical outcomes after hip fracture are significantly associated with patients' pre-fracture residence status. Place of residence as well as functional and cognitive status on admission may lead to differences in functional recovery and affect therapeutic and rehabilitative decision-making.
本研究报告了患者在住院后 1 年内的股骨近端骨折的临床结果。特别评估了患者的临床状况与其骨折前居住地之间的关系（居住在社区或养老院）。
本前瞻性、单中心观察性研究纳入了年龄≥60 岁的股骨近端骨折患者，并对其随访 12 个月。在基线时比较患者的临床状况和 12 个月后的健康状况。使用几种标准化问卷评估患者的功能和认知能力（例如，Lawton 工具性日常生活活动量表、巴氏指数和简易精神状态检查）、活动能力（计时起立行走测试、Tinetti 测试和 Harris 髋关节评分）、生活质量（EuroQol-5 维度指数和 EuroQol 视觉模拟量表）和心理状态（老年抑郁量表）。
本研究共纳入 402 名患者（平均年龄 81.3±8.2 岁，72%为女性）。患者平均住院时间为 13.7±6.1 天。基线时和 12 个月随访时的临床状况比较显示，简易精神状态检查和 Charlson 合并症指数无变化（P=0.527 和 P=0.705），抑郁程度（老年抑郁量表）显著降低（P<0.001），生活质量（EuroQol-5 维度指数）降低（P<0.001）。尽管患者在 12 个月后活动能力增加（计时起立行走测试和 Harris 髋关节评分的 P<0.001），但功能能力显著降低（巴氏指数和 Lawton 工具性日常生活活动量表的 P<0.001）。与居住在社区的个体相比，养老院居民在基线时功能障碍更严重，在 12 个月随访时功能和认知测试的改善程度较低。
髋部骨折后的临床结果与患者骨折前的居住状况显著相关。入院时的居住地点以及功能和认知状态可能导致功能恢复的差异，并影响治疗和康复决策。
