Hip Fractures Among Nursing Home Residents Lead to Poor Survival and Functional Outcomes

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A group of medical specialists completed a study, “Survival and Functional Outcomes after hip fractures among nursing home residents,” because little was known regarding outcomes after hip fractures among long-term nursing home residents.

The group’s objective was to describe patterns and predictors of mortality and functional decline in activities of daily living (ADLs) among nursing home residents after hip fracture. The group did a retrospective cohort study of 60,111 Medicare beneficiaries residing in nursing homes who were hospitalized with hip fractures between July 1, 2005, and June 30, 2009.

The main outcomes included death from any cause at 180 days after fracture and a composite outcome of death or new total dependence in locomotion at the latest available assessment within 180 days. Additional analyses described within-residents changes in function in 7 ADLs before and after fracture.

Study results show that hip fractures lead to higher rates of death in nursing home population

The results found that, of 60,111 patients, 21,766 (36.2%) died by 180 days after fracture; among patients not totally dependent in locomotion at baseline, 53.5% died or developed new total dependence within 180 days. The group also found that within individual patients, function declined substantially after fracture across all ADL domains assessed.

In adjusted analyses, the greatest decreases in survival after fracture occurred with age older than 90 years; nonoperative fracture management (vs internal fixation), and advanced comorbidity. The combined risk of death or new total dependence in locomotion within 180 days was greatest among patients with very severe cognitive impairment, patients receiving nonoperative management, and patients older than 90 years.

Conclusion of study: survival outcomes poor for certain Nursing Home residents who suffer hip fracture

The conclusions of the study were that survival and functional outcomes are poor after hip fracture among nursing home residents, particularly for patients receiving nonoperative management, the oldest old, and patients with multiple comorbidities and advanced cognitive impairment.

The relevance of the study was that care planning should incorporate appropriate prognostic information related to outcomes in this population.

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