Division of Rheumatology and Department of Medicine, Hospital for Special Surgery & Weill Cornell Medicine, New York, NY.
Division of General Internal Medicine, Weill Cornell Medicine, New York, NY.
J Orthop Trauma. 2024 Apr 1;38(4):e149-e156. doi: 10.1097/BOT.0000000000002772.
To evaluate whether social isolation or loneliness is associated with outcomes 1 year after low-energy hip fracture.
Prospective inception cohort study.
Academic level I trauma center.
Participants were 65 years or older and enrolled 2-4 days after surgery for a first low-energy hip fracture. Exclusion criteria were bilateral or periprosthetic hip fracture, previous hip fracture, non-English speaking, international address, active cancer, stage 4 cancer in the past 5 years, radiation to the hip region, and cognitive impairment. Participants were followed longitudinally for 1 year.
The patient-reported outcomes measurement information system (PROMIS)-29 was elicited 2-4 days postoperatively and 1 year later. Patient-reported risk factors included the Lubben Social Networks Scale and the University of California, Los Angeles Loneliness Scale, which were compared with the lower extremity activity scale and PROMIS-29 domains.
Three hundred and twenty-five patients were enrolled. Participants had a median age of 81.7 years, were 70.9% female, and were 85.9% White. In total, 31.6% of patients were socially isolated at the time of fracture. At 1 year, 222 of the 291 subjects who were confirmed alive at 1 year provided data. Multivariable linear models were performed separately for each outcome, including lower extremity activity scale and PROMIS-29 domains. Controlling for age, sex, education, and body mass index, those who were socially isolated at the time of fracture had worse PROMIS-29 function (β = -3.83; P = 0.02) and ability to participate in social roles (β = -4.17; P = 0.01) at 1 year. Secondary analyses found that prefracture loneliness was associated with clinically meaningfully worse function, anxiety, depression, fatigue, sleep, pain, and ability to participate in social roles at 1 year (all P < 0.01).
Prefracture social isolation was associated with worse outcomes 1 year after surgical repair of low-energy hip fracture. These data suggest loneliness may be more strongly associated with important patient-centric metrics than prefracture social isolation. Given the dearth of modifiable risk factors in this population, future studies are needed to evaluate whether improving social connections could affect outcomes in this rapidly growing demographic.
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
评估社交孤立或孤独是否与低能量髋部骨折后 1 年的结局相关。
前瞻性发病队列研究。
学术一级创伤中心。
参与者年龄在 65 岁或以上，并在初次低能量髋部骨折手术后 2-4 天入组。排除标准为双侧或假体周围髋部骨折、既往髋部骨折、非英语、国际地址、活动性癌症、过去 5 年内癌症处于第 4 期、髋部放疗以及认知障碍。参与者进行了为期 1 年的纵向随访。
术后 2-4 天和 1 年后，通过患者报告结局测量信息系统（PROMIS）-29 获得患者报告的结局。患者报告的风险因素包括 Lubben 社会网络量表和加利福尼亚大学洛杉矶孤独量表，这些因素与下肢活动量表和 PROMIS-29 域进行了比较。
共纳入 325 例患者。参与者的中位年龄为 81.7 岁，70.9%为女性，85.9%为白人。在骨折发生时，共有 31.6%的患者处于社会孤立状态。在 1 年时，291 名有确认在 1 年时存活的受试者中有 222 名提供了数据。对每个结局（包括下肢活动量表和 PROMIS-29 域）分别进行多变量线性模型分析。在校正年龄、性别、教育程度和体重指数后，骨折时处于社会孤立状态的患者在 1 年时的 PROMIS-29 功能（β=-3.83；P=0.02）和参与社会角色的能力（β=-4.17；P=0.01）更差。次要分析发现，骨折前的孤独与 1 年时功能、焦虑、抑郁、疲劳、睡眠、疼痛和参与社会角色的能力明显更差相关（均 P<0.01）。
骨折前的社会孤立与低能量髋部骨折手术后 1 年的结局较差相关。这些数据表明，与骨折前的社会孤立相比，孤独可能与更重要的以患者为中心的指标更密切相关。鉴于该人群中缺乏可改变的风险因素，需要进一步研究以评估改善社交联系是否会影响这一日益增长的人群的结局。
预后水平 I。请参阅作者说明以获取完整的证据水平描述。
