Factors associated with short-term functional recovery in elderly people with a hip fracture. Influence of cognitive impairment

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Abstract

OBJECTIVES: To assess factors associated with functional recovery and determine the influence of cognitive impairment. DESIGN: Prospective cohort study. SETTING: Orthogeriatric rehabilitation ward. PARTICIPANTS: A total of 314 older adults (≥65 years) admitted for rehabilitation after a hip operation. MEASUREMENTS: Patients were stratified according to the Mini Mental State Examination into the following categories: severe cognitive impairment, scores 0 to 15; mild cognitive impairment, scores 16 to 23; and no cognitive impairment, scores ≥24. Their functional status, in terms of activities of daily living (ADLs), was recorded, and their ability to walk was measured with the Functional Ambulation Categories at 3 points in time: basal, on admission, and on discharge. We considered recovery of ADLs and ability to walk to be positive responses to rehabilitation treatment. RESULTS: Of the patients included, 285 finished the study (16 patients were moved to another hospital and 13 patients died) and 280 received rehabilitation treatment, with all 3 groups achieving functional gain (P < .01). Fifty-eight percent of patients recovered both the autonomy in ADLs they had before the fracture and the ability to walk (73.7% without cognitive impairment, 50% mild cognitive impairment, and 5% severe cognitive impairment) (P < .001). Previous walking ability (odds ratio [OR] 5.57, 95% confidence interval [CI] 2.41-12.74) together with the presence of pressure ulcers (OR 11.12, 95% CI 2.88-43.29) and delirium (OR 3.20, 95% CI 1.07-9.52) are sturdier predictive factors for functional recovery than the degree of cognitive impairment (OR 1.12, 95% CI 1.04-1.22). CONCLUSION: Previous walking ability and the presence of complications, such as pressure ulcers or delirium, play a greater role in functional recovery than cognitive impairment. Not considering these aspects could lead to an overestimation of the impact of cognitive impairment in the recovery of these patients.

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