Rehabilitation outcomes after hip fracture in persons 90 years old and older

Within the geriatric population, fracture of the proximal femur is a major problem that may lead to high mortality. Epidemiologists have reported that age greater than 75 is a negative factor in rehabilitation. In two studies, less than 10% of persons aged 90 and over regained ambulatory or prefracture status. This retrospective study describes the outcomes of rehabilitation of persons 90 years and older with fracture of the proximal femur. During a one-year period, 18 persons (17 women, one man), range 91 to 102 years (means 93 years), were referred from ten hospitals for rehabilitation after hip fracture. Eight physical therapists were involved at six different skilled nursing facilities covering a geographical area of 2300 square miles. The sample was determined to represent the regional population. Upon final physical therapy treatment all 16 surviving patients needed an assistive device for ambulation; 63% of the subjects attained independent ambulation; the average ambulatory distance was 133 ft; and 44% returned home. At one-year follow-up, 12/16 original patients survived, nine remaining patients were independent in ambulation, of whom five were at home. Under the prospective payment system with diagnosis-related groups, peculiar decisions are made that have an impact upon rehabilitation. Recovery of independent ambulation is an excellent index of rehabilitation outcome.