School of Nursing, University of Texas Medical Branch, Galveston, USA.
Sealy Center on Aging, University of Texas Medical Branch, Galveston, USA.
J Gerontol A Biol Sci Med Sci. 2023 Aug 27;78(9):1677-1682. doi: 10.1093/gerona/glad063.
Repeat fractures contribute substantially to fracture incidents in older adults. We examined the association between cognitive impairment and re-fractures during the first 90 days after older adults with hip fractures were discharged home from a skilled nursing facility rehabilitation short stay.
Multilevel binary logistic regression was used to analyze 100% of U.S. national postacute-care fee-for-service Medicare beneficiaries who had a hospital admission for hip fracture from January 1, 2018, to July 31, 2018; were admitted for a skilled nursing facility stay within 30 days of hospital discharge; and were discharged to the community after a short stay. Our primary outcome was rehospitalization for any re-fractures within 90 days of skilled nursing facility discharge. Cognitive status assessed at skilled nursing facility admission or before discharge was classified as either intact or having mild or moderate/severe impairment.
In 29 558 beneficiaries with hip fracture, odds of any re-fracture were higher in those with minor (odds ratio: 1.48; 95% confidence interval: 1.19-1.85; p < .01) and moderate/major cognitive impairment (odds ratio: 1.42; 95% confidence interval: 1.07-1.89; p = .0149) than in those classified as intact.
Beneficiaries with cognitive impairment were more likely than their counterparts with no cognitive impairment to experience re-fractures. Community-dwelling older adults with minor cognitive impairment may experience a higher likelihood of experiencing a repeat fracture leading to rehospitalization.
重复骨折在老年人中占骨折事件的很大比例。我们研究了认知障碍与老年人髋部骨折从康复短期护理机构出院后 90 天内再骨折之间的关系。
使用多级二项逻辑回归分析了 2018 年 1 月 1 日至 7 月 31 日期间美国全国急性后护理服务 Medicare 付费受益人的 100%，他们因髋部骨折住院治疗；在出院后 30 天内入住康复护理机构；并在短期停留后出院到社区。我们的主要结局是在康复护理机构出院后 90 天内因任何再骨折而再次住院。在康复护理机构入院或出院前评估的认知状态分为完整、轻度或中度/重度障碍。
在 29558 名髋部骨折受益人中，有轻微认知障碍（比值比：1.48；95%置信区间：1.19-1.85；p <.01）和中度/重度认知障碍（比值比：1.42；95%置信区间：1.07-1.89；p =.0149）的人再次骨折的可能性高于认知完整的人。
与没有认知障碍的患者相比，有认知障碍的患者更有可能再次骨折。有轻微认知障碍的居住在社区的老年人可能更有可能经历导致再次住院的重复骨折。
