Department of Medical Sciences, University of Turin, Corso A. M. Dogliotti 14, Torino, 10126, Italy.
Division of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy.
Aging Clin Exp Res. 2024 Oct 12;36(1):206. doi: 10.1007/s40520-024-02857-w.
Hip fracture is a common event in older adults, leading to an increased risk of mortality, disability, and higher healthcare costs. Early in-hospital rehabilitation after surgery within orthogeriatric units may improve outcomes with limited incident complications even in the oldest old. We aimed to determine the prevalence and predictors of non-adherence to early rehabilitation in the orthogeriatric unit of an Italian tertiary hospital and its impact on outcomes and setting at discharge.
Retrospective observational single-centered cohort study. Patients aged ≥ 65 years admitted to the orthogeriatric unit for hip fracture who underwent surgery between April 2019 and October 2020 were considered eligible if able to walk autonomously or with assistance and independent in at least 2 Basic Activities of Daily Living. Along with sociodemographic and geriatric variables, characteristics of surgery and rehabilitation, in-hospital complications and functional outcomes at discharge were collected. The primary outcome was non-adherence to the early in-hospital rehabilitation program.
Among 283 older patients (mean age 82.7 years, 28.6% male), non-compliance with physical therapy was assessed in 49 cases (17.3%), characterized by worse pre-fracture clinical, cognitive, and functional status and showing worse outcomes in terms of mobilization at discharge. After multivariable analysis, non-adherence was independently associated with the onset of delirium (OR 5.26, 95%CI 2.46-11.26; p < 0.001) or infections after surgery (OR 3.26, 95%CI 1.54-6.89; p < 0.001) and a systolic blood pressure at admission < 120 mmHg (OR 4.52, 95%CI 1.96-10.43, p < 0.001).
Pre-fracture poor cognitive and functional status, along with lower systolic blood pressure, seem to make some patients more vulnerable to in-hospital complications (mainly delirium and infections) and negatively affect the adherence to physical therapy and, by consequence, clinical outcomes of rehabilitation.
髋部骨折是老年人中常见的事件，会导致死亡率、残疾率和医疗保健费用增加。在矫形老年医学病房内手术后尽早进行院内康复治疗可能会改善预后，即使在最年长的老年人中也能减少并发症的发生。我们旨在确定意大利一家三级医院矫形老年医学病房内不遵守早期康复治疗的发生率和预测因素及其对出院时结局和环境的影响。
回顾性观察性单中心队列研究。2019 年 4 月至 2020 年 10 月期间因髋部骨折入住矫形老年医学病房并接受手术的年龄≥65 岁的患者，如果能够自主或辅助行走并且至少在 2 项基本日常生活活动中独立，则被认为符合条件。收集了社会人口学和老年学变量、手术和康复特征、院内并发症以及出院时的功能结局。主要结局是不遵守早期院内康复计划。
在 283 名老年患者（平均年龄 82.7 岁，28.6%为男性）中，有 49 例（17.3%）不符合物理治疗，这些患者的骨折前临床、认知和功能状态较差，出院时的活动能力较差。多变量分析后，不遵守治疗与谵妄发作（OR 5.26，95%CI 2.46-11.26；p<0.001）或手术后感染（OR 3.26，95%CI 1.54-6.89；p<0.001）以及入院时收缩压<120mmHg（OR 4.52，95%CI 1.96-10.43，p<0.001）独立相关。
骨折前较差的认知和功能状态以及较低的收缩压似乎使一些患者更容易发生院内并发症（主要是谵妄和感染），并对物理治疗的依从性产生负面影响，从而影响康复的临床结局。
