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Severity of cognitive impairment as a prognostic factor for mortality and functional recovery of geriatric patients with hip fracture
Author(s) -
TarazonaSantabalbina Francisco José,
BelenguerVarea Ángel,
Rovira Daudi Eduardo,
Salcedo Mahiques Enmanuel,
Cuesta Peredó David,
DoménechPascual Juan Ramón,
Gac Espínola Homero,
Avellana Zaragoza Juan Antonio
Publication year - 2015
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.12271
Subject(s) - medicine , hip fracture , delirium , dementia , barthel index , observational study , cognitive impairment , activities of daily living , physical therapy , osteoporosis , disease , intensive care medicine
Aim To identify how the severity of dementia influences functional recovery and mortality in elderly patients hospitalized for hip fracture. Methods An observational retrospective study of 1258 patients aged older than 69 years and diagnosed with hip fracture who received care within an orthogeriatrics unit from 2004 to 2008 was carried out. During a 12‐month follow‐up period, functional recovery and mortality outcomes were measured. Results Dementia was present in 383 (28.1%) patients: it was mild in 183 (48%), moderate in 102 (26.5%) and severe in 98 (25.5%). Compared with patients with preserved cognitive status, patients with dementia had the following statistically significant differences (means [standard deviation] or percentage): older age (preserved, 82.29 years [6.5 years]; mild, 83.63 years [6.1 years]; moderate, 83.47 years [5.9 years]; severe, 84.46 years [6.1 years]; P < 0.001); lower B arthel I ndex (89.7 [21.6], 72.7 [24.6], 58.9 [28.6], 38.0 [28.1]; P < 0.001); delirium (11.7%, 25.6%, 37.6%, 44.7%; P < 0.001); less ambulation at 6 months postdischarge (83.9%, 72.8%, 56.9%, 41.7%; P < 0.001); and higher mortality at discharge (4%, 5.7%, 8.2%, 10.6%; P < 0.001) and 12 months after discharge (21.2%, 32.3%, 46.3%, 53.5%; P < 0.001). Patients with severe dementia had lower probability of functional recovery at discharge ( OR 0.272, 95% CI 0.140–0.526, P < 0.001) and 6 months after discharge ( OR 0.439, 95% CI 0.197–0.979, P = 0.04), as well as a greater probability of dying ( HR 1.640, 95% CI 1.020–2.635, P = 0.04). Conclusions We observed higher 12‐month mortality and less functional recovery with increasing severity of dementia. Geriatr Gerontol Int 2015; 15: 289–295.