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Mobility after hip fracture predicts health outcomes
K M Fox1, W G Hawkes, J R Hebel
1Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, USA.
Objectives:
Balance and gait are essential to physical functioning and the performance of activities of daily living. The objective of this study was to determine the predictive value of a balance and gait test on subsequent mortality, morbidity, and healthcare utilization among older hip fracture patients.
Design:
A prospective study of hip fracture recovery.
Setting:
Patients with a new hip fracture admitted from the community to one of eight Baltimore hospitals and followed in their homes for 2 years postfracture.
Participants:
A total of 306 patients with hip fracture, 65 years of age and older, who completed a gait and balance assessment at 2 months postfracture.
Measurements:
The relationship between gait and balance test performance at 2 months postfracture and mortality, physician visits, rehospitalizations, nursing home placement, and falls up to 24 months postfracture was assessed by Cox proportional hazards and least squares regression.
Results:
After adjusting for age, sex, race, and comorbidity, the balance score and the summary mobility score predicted mortality. A 17% increase in the risk of mortality was demonstrated for each unit decrease in the balance score (range 0-17), and a 10% increase was demonstrated for each decrease in the summary score (range 0-26). Unsteady balance during immediate standing, turning, sitting down, and rising from a chair were associated significantly with increased mortality. Poor balance, but not poor gait, was associated with an increase in hospitalizations up to 24 months postfracture. Both poor balance and poor gait were associated with nursing home placement, with 20% and 17% increased odds, respectively. Mobility did not predict future physician visits or falls.
Conclusions:
These findings demonstrate that balance and gait are predictive of future health outcomes for older hip fracture patients.