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Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the
P P Ríos-Germán1, R Menéndez-Colino1, R Ramírez Martin1
1Servicio de Geriatría, Hospital Universitario La Paz, Madrid, España.
Insights
Nursing home patients with hip fractures face higher surgical risks and functional decline compared to community-dwelling patients. While mortality rates are similar, nursing home residents less frequently regain their prior walking ability one year post-fracture.
Area of Science:
- Geriatric Medicine
- Orthopedics
- Public Health
Background:
- Hip fractures (HF) are a significant health concern, particularly in older adults.
- Outcomes after hip fracture can differ based on living environment, such as nursing homes (NH) versus community-dwelling (CD).
Purpose of the Study:
- To compare clinical and functional differences in hip fracture patients admitted from nursing homes versus community settings.
- To assess outcomes, including mortality and functional recovery, at one year post-hip fracture.
Main Methods:
- Prospective inclusion of hip fracture patients admitted to an orthogeriatric unit.
- Collection of clinical, functional, and mortality data during hospital admission.
- 1-year follow-up via telephone to assess vital status and functional status.
Main Results:
- Nursing home patients exhibited higher surgical risk (ASA ≥3), poorer vital prognosis, and greater pre-fracture functional and mental impairment.
- A higher prevalence of sarcopenia was observed in nursing home patients.
- No significant differences in in-hospital or 1-year mortality were found between groups.
- Nursing home patients had a lower rate of recovery of previous walking capacity at 1 year.
Conclusions:
- Nursing home patients with hip fractures present with greater comorbidities and functional deficits compared to community-dwelling patients.
- Despite similar mortality rates, nursing home residents experience a more significant reduction in mobility recovery after hip fracture.
Objective:
To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients.
Methods:
All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status.
Results:
A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001).
Conclusions:
Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.
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