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Relationships between frailty and health-related outcomes over the first two years after hip-fracture surgery: A
Yu-Hua Hsu1, Jersey Liang2, Ming-Yueh Tseng3
1School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
Objectives:
This study examined associations between frailty status and health-related outcomes for older adults over two years following hip-fracture surgery.
Design:
A prospective longitudinal cohort study.
Setting And Participants:
Older adults (aged ≥ 60 years) who had undergone hip-fracture surgery and met inclusion criteria were recruited from a 3000-bed medical center in northern Taiwan from September 2012 to March 2019 (N = 318).
Methods:
The independent variable of frailty status was assessed with a researcher-modified Clinical Frailty Scale. Baseline measures for health-related variables (pre-fracture basic activities of daily living (BADLs), physical and mental component scores for health-related quality of life (HRQoL), and number of fall incidences) were collected 1-month following hospital discharge. Follow-up assessments of frailty and health-related variables were assessed at 3- to 24-months post-discharge. Group-based trajectory modeling identified three frailty trajectory groups. Changes in frailty status associated with outcome variables were analyzed using generalized estimating equations (GEE).
Results:
Most participants were in the pre-frail trajectory group (52.6%); 33.5% were frail; 15.0% were robust. There were significant differences among trajectory groups for baseline health-related variables of pre-fracture BADLs (P < .001) and mental HRQoL (P = .01); the frail trajectory group had the poorest scores for both variables. GEE analysis indicted frailty status significantly influenced recovery of BADLs: compared with participants with a robust frailty status, BADLs were lower for those with a status of pre-frail (β = -0.675, P = .012) and frail (β = -2.349, P = .001). Physical-HRQoL scores were also lower for those who were pre-frail (β = -6.697, P < .001) and frail (β = -9.775, P < .001).
Conclusions And Implications:
Frailty status was significantly associated with health-related outcomes following hip-fracture surgery. Assessing frailty status longitudinally could guide the development of early interventions to reduce frailty, improve recovery, enhance quality of life, and reduce falls for older adults discharged from hospital following hip-fracture surgery.
