Skip to main content

Advertisement

SpringerLink
Log in

Trajectories and prognostic factors for recovery after hip fracture: a longitudinal cohort study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine recovery trajectories and prognostic factors for poor recovery in frail and non-frail patients after hip fracture.

Methods

Patients with a hip fracture aged 65 years and older admitted to a hospital in the Netherlands from August 2015 to November 2016 were asked to complete questionnaires at one week and one, three, six, 12, and 24 months after injury. The questionnaires included the ICEpop CAPability measure for older people, Health Utility Index, and the Hospital Anxiety Depression Scale. Latent class trajectory analysis was used to determine trajectories of recovery. Patient and injury characteristics for favourable and unfavourable outcome were compared with logistic regression.

Results

In total, 696 patients were included of which 367 (53%) patients were frail. Overall, recovery trajectories in frail patients were worse compared to trajectories in non-frail patients. In frail patients, poor recovery was significantly associated with dementia. Lower age was a prognostic factor for good recovery. Immobility, loneliness and weight loss were prognostic for respectively poor capability and symptoms of anxiety and depression. In non-frail patients, recovery after hip fracture was associated with loneliness and the type of hip fracture.

Conclusion

Although frailty is associated with poor recovery in older patients with hip fracture, a large proportion of frail patients show good recovery. Loneliness determines poor recovery with anxiety and depressive symptoms.

Trail registration

ClinicalTrials.gov identifier: NCT02508675 (July 27, 2015).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

Data are available on reasonable request. Requests may be sent to secretariaat@nazb.nl.

Abbreviations

ASA:

American Society of Anesthesiologists Physical Status Classification System

BIOS:

Brabant Injury Outcome Surveillance

GFI:

Groningen Frailty Indicator

ICECAP-O:

Icepop capability measure for Older people

HADS:

Hospital Anxiety and Depression Scale

HUI:

Health Utility index

References

  1. Peeters CM, Visser E, Van de Ree CL, Gosens T, Den Oudsten BL, De Vries J (2016) Quality of life after hip fracture in the elderly: a systematic literature review. Injury 47(7):1369–1382

    Article  PubMed  Google Scholar 

  2. van de Ree C, de Munter L, Biesbroeck B, Kruithof N, Gosens T, de Jongh M (2020) The prevalence and prognostic factors of psychological distress in older patients with a hip fracture: a longitudinal cohort study. Injury 51(11):2668–2675

    Article  PubMed  Google Scholar 

  3. Beaupre LA, Jones CA, Johnston DWC, Wilson DM, Majumdar SR (2012) Recovery of function following a hip fracture in geriatric ambulatory persons living in nursing homes: prospective cohort study. J Am Geriatr Soc 60(7):1268–1273

    Article  PubMed  Google Scholar 

  4. Tang VL, Sudore R, Cenzer IS, Boscardin WJ, Smith A, Ritchie C et al (2017) Rates of recovery to pre-fracture function in older persons with hip fracture: an observational study. J Gen Intern Med 32(2):153–158

    Article  PubMed  Google Scholar 

  5. Griffin X, Parsons N, Achten J, Fernandez M, Costa M (2015) Recovery of health-related quality of life in a United Kingdom hip fracture population: the Warwick Hip Trauma Evaluation-a prospective cohort study. Bone Joint J 97(3):372–382

    Article  PubMed  Google Scholar 

  6. Xue Q-L (2011) The frailty syndrome: definition and natural history. Clin Geriatr Med 27(1):1

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  7. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J et al (2001) Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 56(3):M146–M157

    Article  PubMed  CAS  Google Scholar 

  8. Lin H-S, Watts J, Peel N, Hubbard R (2016) Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr 16(1):1–12

    Article  Google Scholar 

  9. van de Ree CL, Landers MJ, Kruithof N, de Munter L, Slaets JP, Gosens T et al (2019) Effect of frailty on quality of life in elderly patients after hip fracture: a longitudinal study. BMJ Open 9:e025941

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cunha AIL, Veronese N, de Melo Borges S, Ricci NA (2019) Frailty as a predictor of adverse outcomes in hospitalized older adults: a systematic review and meta-analysis. Ageing Res Rev 56:100960

    Article  PubMed  Google Scholar 

  11. Bruun-Olsen V, Bergland A, Heiberg KE (2018) “I struggle to count my blessings”: recovery after hip fracture from the patients’ perspective. BMC Geriatr 18(1):1–9

    Article  Google Scholar 

  12. Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID et al (2016) A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 16(1):1–18

    Article  Google Scholar 

  13. de Jongh MA, Kruithof N, Gosens T, van de Ree CL, de Munter L, Brouwers L et al (2017) Prevalence, recovery patterns and predictors of quality of life and costs after non-fatal injury: the Brabant Injury Outcome Surveillance (BIOS) study. Inj Prev 23(1):59–59

    Article  PubMed  Google Scholar 

  14. Steverink N (2001) Measuring frailty: developing and testing the GFI (Groningen Frailty Indicator). Gerontologist 41:236

    Google Scholar 

  15. Peters LL, Boter H, Buskens E, Slaets JP (2012) Measurement properties of the Groningen Frailty Indicator in home-dwelling and institutionalized elderly people. J Am Med Dir Assoc 13(6):546–551

    Article  PubMed  Google Scholar 

  16. Grewal I, Lewis J, Flynn T, Brown J, Bond J, Coast J (2006) Developing attributes for a generic quality of life measure for older people: preferences or capabilities? Soc Sci Med 62(8):1891–1901

    Article  PubMed  Google Scholar 

  17. Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JJ et al (2008) Valuing the ICECAP capability index for older people. Soc Sci Med 67(5):874–882

    Article  PubMed  Google Scholar 

  18. Makai P, Koopmanschap MA, Brouwer WB, Nieboer AA (2013) A validation of the ICECAP-O in a population of post-hospitalized older people in the Netherlands. Health Qual Life Outcomes 11(1):1–11

    Article  Google Scholar 

  19. Horsman J, Furlong W, Feeny D, Torrance G (2003) The Health Utilities Index (HUI®): concepts, measurement properties and applications. Health Qual Life Outcomes 1(1):1–13

    Article  Google Scholar 

  20. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370

    Article  PubMed  CAS  Google Scholar 

  21. Vermunt JK, Magidson J, (2016) Upgrade manual for Latent GOLD 5.1. Belmont, MA: Statistical Innovations

  22. Mosk CA, Mus M, Vroemen JP, van der Ploeg T, Vos DI, Elmans LH et al (2017) Dementia and delirium, the outcomes in elderly hip fracture patients. Clin Interv Aging 12:421

    Article  PubMed  PubMed Central  Google Scholar 

  23. Seitz DP, Gill SS, Gruneir A, Austin PC, Anderson GM, Bell CM et al (2014) Effects of dementia on postoperative outcomes of older adults with hip fractures: a population-based study. J Am Med Dir Assoc 15(5):334–341

    Article  PubMed  Google Scholar 

  24. Waite L, Grayson D, Piguet O, Creasey H, Bennett H, Broe G (2005) Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J Neurol Sci 229:89–93

    Article  PubMed  Google Scholar 

  25. Robinson TN, Raeburn CD, Tran ZV, Angles EM, Brenner LA, Moss M (2009) Postoperative delirium in the elderly: risk factors and outcomes. Ann Surg 249(1):173–178

    Article  PubMed  Google Scholar 

  26. Koizia LJ, Wilson F, Reilly P, Fertleman MB (2019) Delirium after emergency hip surgery–common and serious, but rarely consented for. World J Orthop 10(6):228

    Article  PubMed  PubMed Central  Google Scholar 

  27. Smith TO, Dainty JR, MacGregor A (2018) Trajectory of social isolation following hip fracture: an analysis of the English Longitudinal Study of Ageing (ELSA) cohort. Age Ageing 47(1):107–112

    Article  PubMed  Google Scholar 

  28. Colón-Emeric C, Whitson HE, Pieper CF, Sloane R, Orwig D, Huffman KM et al (2019) Resiliency groups following hip fracture in older adults. J Am Geriatr Soc 67(12):2519–2527

    Article  PubMed  PubMed Central  Google Scholar 

  29. Rebagliati GAA, Sciumé L, Iannello P, Mottini A, Antonietti A, Caserta VA et al (2016) Frailty and resilience in an older population. The role of resilience during rehabilitation after orthopedic surgery in geriatric patients with multiple comorbidities. Funct Neurol 31(3):171

    PubMed  PubMed Central  CAS  Google Scholar 

  30. Hebert-Davies J, Laflamme G-Y, Rouleau D (2012) Bias towards dementia: are hip fracture trials excluding too many patients? Syst Rev Injury 43(12):1978–1984

    Article  Google Scholar 

  31. Haagsma J, Bonsel G, de Jongh M, Polinder S (2019) Agreement between retrospectively assessed health-related quality of life collected 1 week and 12 months post-injury: an observational follow-up study. Health Qual Life Outcomes 17(1):1–10

    Article  Google Scholar 

  32. Hansson S, Rolfson O, Åkesson K, Nemes S, Leonardsson O, Rogmark C (2015) Complications and patient-reported outcome after hip fracture. A consecutive annual cohort study of 664 patients. Injury 46(11):2206–11

    Article  PubMed  Google Scholar 

  33. Carpintero P, Caeiro JR, Carpintero R, Morales A, Silva S, Mesa M (2014) Complications of hip fractures: a review. World J Orthop 5(4):402

    Article  PubMed  PubMed Central  Google Scholar 

  34. Resnick B, Beaupre L, McGilton KS, Galik E, Liu W, Neuman MD et al (2016) Rehabilitation interventions for older individuals with cognitive impairment post-hip fracture: a systematic review. J Am Med Dir Assoc 17(3):200–205

    Article  PubMed  Google Scholar 

  35. Stenvall M, Berggren M, Lundström M, Gustafson Y, Olofsson B (2012) A multidisciplinary intervention program improved the outcome after hip fracture for people with dementia—subgroup analyses of a randomized controlled trial. Arch Gerontol Geriatr 54(3):e284–e289

    Article  PubMed  Google Scholar 

  36. Sciumè L, Rebagliati GAA, Iannello P, Mottini A, Alessandro A, Caserta AV et al (2018) Rehabilitation after urgent or elective orthopedic surgery: the role of resilience in elderly patients. Rehabil Nursing J 43(5):267–274

    Article  Google Scholar 

  37. Erivan R, Hacquart T, Villatte G, Mulliez A, Descamps S, Boisgard S (2021) Place of residence before and place of discharge after femoral neck fracture surgery are associated with mortality: a study of 1238 patients with at least three years’ follow-up. Orthop Traumatol Surg Res 107(3):102876

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by a grant of the Dutch organisation for health research and care innovation (ZonMW) section TopCare projects (grant number: 80842009814225).

Author information

Authors and Affiliations

  1. Department Trauma TopCare, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Leonie de Munter, Taco Gosens & Mariska A. C. de Jongh

  2. Department of Orthopaedic Surgery, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Cornelis L. P. van de Ree, Olav P. van der Jagt & Taco Gosens

  3. Center of Research On Psychological and Somatic Disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, 5037 AB, Tilburg, The Netherlands

    Taco Gosens

  4. Department of Geriatric Medicine, ETZ Hospital (Elisabeth-TweeSteden Ziekenhuis), Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Huub A. A. M. Maas

  5. Brabant Trauma Registry, Network Emergency Care Brabant, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands

    Mariska A. C. de Jongh

Authors
  1. Leonie de Munter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cornelis L. P. van de Ree
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Olav P. van der Jagt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Taco Gosens
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Huub A. A. M. Maas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mariska A. C. de Jongh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

LM, HM and MJ contributed to the conception and design of this study. LM and CR contributed to the data collection. LM, CR, OJ, TG, HM and MJ contributed to the analyses and interpretation. LM, CR, OJ, TG, HM and MJ contributed to the preparation of the manuscript. The final version of the manuscript was approved by all the authors.

Corresponding author

Correspondence to Leonie de Munter.

Ethics declarations

Ethics approval

This study was approved by Medical Ethics Committee Brabant (NL50258.02814).

Consent to participate

Informed consent was obtained from all the individual participants included in the study.

Consent for publication

The authors affirm that human research participants provided informed consent for publication.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 692 KB)

Supplementary file2 (PDF 428 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

de Munter, L., van de Ree, C.L.P., van der Jagt, O.P. et al. Trajectories and prognostic factors for recovery after hip fracture: a longitudinal cohort study. International Orthopaedics (SICOT) 46, 2913–2926 (2022). https://doi.org/10.1007/s00264-022-05561-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05561-4

Keywords

Search

Navigation