Factors associated to institutionalization and mortality over three years, in elderly people with a hip fracture-An observational study.

OBJECTIVE

To identify the factors associated to institutionalization and mortality in elderly patients with hip fractures (HF).

DESIGN

Thirty-six months observational study.

SETTING

A post-acute rehabilitation ward.

PARTICIPANTS

subjects living in the community or in nursing-home, above the age of 65, with HF.

MEASUREMENTS: The following were registered: comorbidity, intra-hospital complications, Barthel index, walking ability and Mini Mental State Examination, as well as blood samples upon admission and discharge. Destination upon discharge was recorded as well as mortality during hospital stay and over the three-year follow up.

RESULTS

a total of 430 subjects were included in the study. Twenty-three patients (5.3%) died during their stay in hospital and 152 (35.3%) during follow up after discharge. Forty-five patients (10.5%) were institutionalized upon discharge. In adjusted analysis, the factors that predict intra-hospital mortality are higher comorbidity (OR, 1.46; 95%CI, 1.06-2.01), and the number of complications (OR, 1.71; 95%CI, 1.16-2.64). Factors that predict mortality in the long term are age (HR 1.04; 95%CI, 1.01-1.06), comorbidity (HR 1.19, 95% CI, 1.09-1.30), the number of complications (HR 1.17, 95%CI, 1.05-1.31). The factors that predicted new institutionalization were age (OR 1.04, 95%CI, 0.98-1.09), living alone (OR 3.95, 95%CI, 1.38-11.3), and length of hospital stay (OR 1.02 95%CI, 1.00-1.03).

CONCLUSIONS

Mortality 3 years after a hip fracture and institutionalization are associated to age, the loss of autonomy in walking, a worse cognitive status and living alone before the fracture. Identification of and, when possible, intervention upon these factors can improve care of elderly people with hip fractures.