Related Experiment Video
Updated: Jun 2, 2025
Assessment of Dependence in Activities of Daily Living Among Older Patients in an Acute Care Unit
Published on: September 30, 2020
Mortality and Function After Hip Fracture or Pneumonia in People With and Without Dementia
Lauren J Hunt1,2,3, R Sean Morrison4,5, Siqi Gan6,7
1Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA.
Background:
The extent to which disruptive surgical or medical events impact mortality and function is critical for anticipatory planning and informing goal-aligned care.
Methods:
Using Health and Retirement Study data (2008-2018), we employed propensity score matching to compare the impact of hospitalization for hip fracture (a surgical event) or pneumonia (a medical event) among people with dementia to two groups: (1) people with dementia who did not experience these events; and (2) people without dementia who experienced an event. Dementia status was determined using validated cognitive assessments (Hurd method); hip fracture and pneumonia were identified from Medicare claims. Outcomes were 1-year mortality and function, defined as a summary score of requiring assistance with 6 ADL's and 5 IADL's, with higher scores indicating better function.
Results:
Among people with dementia, predicted 1-year mortality was higher among those with hip fracture (35.4%) versus those without hip fracture (14.8%), with similar patterns for pneumonia (49.6% vs. 13.0%). Among people with dementia, function declined abruptly at time of hip fracture (-2.09 [95% CI -2.94, -1.25]) and continued to decline after (-0.48 [95% CI -0.87, -0.09]). There were similar patterns for pneumonia (drop at time of pneumonia of -1.49 [95% CI -2.0, -0.97] and after -0.05 [95% CI, -0.29, 0.19]). Compared to people without dementia with hip fracture, people with dementia had higher 1-year mortality (35.4%) versus people without dementia (24%), with similar patterns for pneumonia (49.6% vs. 39.7%). Function stabilized for people without dementia after hip fracture (-0.03, 95% CI -0.22, 0.16), which was significantly different than people without dementia (p < 0.0001). Function improved for people without dementia after pneumonia (0.13, 95% CI 0.03, 0.24), but was not statistically different than for people with dementia (p = 0.17).
Conclusion:
Disruptive events such as hip fracture or pneumonia substantially alter the clinical trajectories of people with dementia.
More Related Videos
08:17A Mouse Model of Orthopedic Surgery to Study Postoperative Cognitive Dysfunction and Tissue Regeneration
Published on: February 27, 2018
05:53Measuring Frailty in HIV-infected Individuals. Identification of Frail Patients is the First Step to Amelioration and Reversal of Frailty
Published on: July 24, 2013
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:29Pneumonia II: Pathophysiology
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....
01:30Dementia
The progression of dementia is generally gradual....