Age and Gender Differences in Functional Recovery Trajectories After Hip Fracture Among Chinese Older Adults: A 9-Year Longitudinal Study.

OBJECTIVES

To characterize trajectories of activities of daily living (ADL) difficulties before and after hip fracture among Chinese older adults and to examine effect modifications by age and gender.

SETTING AND

PARTICIPANTS

A prospective cohort study utilizing data from the China Health and Retirement Longitudinal Study (2011-2020), including 25,873 participants (719 with incident hip fracture).

METHODS

ADL difficulties were assessed using the 6-item Katz Index of ADL scale based on patient self-report. Linear mixed-effects models examined trajectories, and interaction terms tested effect modification by age and gender.

RESULTS

Hip fracture was associated with an immediate increase of 0.580 ADL difficulties (P < .001), followed by gradual annual recovery. Age significantly modified fracture impact (interaction: β = 0.033; P < .001). The 70 to 79 age group was most vulnerable, with an immediate increase of 0.908 ADL difficulties, whereas those aged ≥80 years exhibited increasing ADL disability during recovery. Male gender was protective against increasing ADL difficulties after fracture (β = -0.185; P = .023). Difficulties remained 25% above prefracture levels at 6 years after fracture.

CONCLUSIONS AND IMPLICATIONS: Age and gender are critical modifiers of functional recovery after hip fracture. The vulnerability of 70 to 79 year olds and the increasing ADL disability during recovery of the oldest-old underscore the need for age-specific rehabilitation strategies in aging populations like China.