Functional decline in nonagenarians admitted for hip fracture

The objective of this study was to determine the characteristics of nonagenarian patients admitted for hip fracture and assess whether they present differences in complications and functional outcomes at discharge compared to younger patients.

Prospective longitudinal study in patients over 75 years of age admitted for hip fracture over a 1-year period. A total of 542 patients were included, of which 165 patients were aged over 90 years (30.9%). Demographic variables, pre-fracture functional status, medical history, type of fracture, functional evolution, discharge destination, and mortality were collected. Differences between the two population groups were analyzed.

Of the 542 patients over 75 years admitted for hip fracture, 165 were aged over 90 years (30.9%), 74.5% were women, 62% were independently ambulatory prior to the fracture, and 70% had a Barthel Index score >60. Cognitive impairment was absent in 49% of cases. Surgical treatment was performed in 91.5% of cases. There were no differences in the baseline status when compared to younger patients (aged 75-89 years) except for a higher likelihood of residing in a nursing home (OR 1.74; CI 1.18-2.55). Nonagenarian patients were at higher risk of not being able to walk at discharge (OR 2.00; CI 1.29-3.10). Discharge to a nursing home or functional recovery unit was more likely (OR 1.85; CI 1.22-2.81).

Patients over 90 years of age are more susceptible to worsening their function during admission and have a higher risk of not being able to walk at discharge. Efforts should be made to reverse this decline in order to reduce the associated mortality.