Mild to moderate cognitive impairment is a major risk factor for mortality and nursing home admission in the first year after hip fracture

Autor: F. Schaller, D. Grob, W. Dick, Bess Dawson-Hughes, E. Sidelnikov, Robert Theiler, Heike A. Bischoff-Ferrari, U. Can, Andreas Platz, Hannes B. Staehelin, Andreas Egli
Přispěvatelé: University of Zurich, Bischoff-Ferrari, H A
Rok vydání: 2012
Předmět:
Male
Pediatrics
medicine.medical_specialty
Histology
11221 Clinic for Geriatric Medicine
Physiology
Endocrinology
Diabetes and Metabolism
2722 Histology
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
360 Social problems & social services
Risk Factors
law
Acute care
medicine
Risk of mortality
Humans
Cognitive Dysfunction
030212 general & internal medicine
Risk factor
Aged
80 and over
2. Zero hunger
Hip fracture
300 Social sciences
sociology & anthropology
Hip Fractures
Proportional hazards model
business.industry
1314 Physiology
medicine.disease
Survival Analysis
Nursing Homes
3. Good health
Hospitalization
2712 Endocrinology
Diabetes and Metabolism
Physical therapy
Population study
Female
business
Body mass index
Switzerland
030217 neurology & neurosurgery
Zdroj: Bone
ISSN: 8756-3282
DOI: 10.1016/j.bone.2012.06.004
Popis: Background: It is not well established if and to what extent mild to moderate cognitive impairment predicts mortality and risk of nursing home admission after hip fracture. Objective: To investigate prospectively whether and to what extent mild to moderate cognitive impairment contributes to mortality and admission to nursing home in the first year after acute hip fracture. Methods: We enrolled 173 patients with acute hip fracture age 65 and older who reached a Mini Mental State Examination (MMSE) score of at least 15 during acute care after hip fracture repair. An MMSE score of 15 to 24 (median) was classified as mild to moderate cognitive impairment. Primary outcomes were mortality in all and admission to nursing home among seniors who lived at home prior to their hip fracture. Follow up was 12 months with clinical visits at baseline 6 and 12 months plus monthly phone calls. We used Cox proportional hazards models controlling for age sex body mass index baseline number of comorbidities and 25 hydroxyvitamin D status and severe incident infections to assess the risk of mortality and nursing home admission. Because the study population was enrolled in a factorial design clinical trial testing high dose vitamin D and/or an exercise home program all analyses also controlled for these treatment strategies. Results: Of 173 acute hip fracture patients enrolled 79 were women 77 were admitted from home and 80 were vitamin D deficient (b20 ng/ml).Mean age was 84 years. 54 hadmild tomoderate cognitive impairment. Over the 12 month follow up 20 patients died (27 of 173) and 47 (35 of 134) were newly admitted to a nursing home. Mild to moderate cognitive impairment was associated with a more than 5 fold increased risk of mortality (HR=5.77; 95 CI: 1.55–21.55) and a more than 7 fold increased risk of nursing home admission (HR=7.37; 95 CI: 1.75–30.95). Additional independent risk factors ofmortality were male gender (HR=3.55; 95 CI: 1.26–9.97) low BMI (HR=7.25; 95 CI: 1.61–33.74) and baseline 25 hydroxyvitamin D level (per 1 ng/ml: HR=0.93; 95 CI: 0.87–0.998; p=0.04). Conclusions: Mild to moderate cognitive impairment in patients with acute hip fracture is associated with a high risk of mortality and nursing home admission during the first year after hip fracture. Female gender a greater BMI and a higher 25 hydroxyvitamin D status may protect against mortality after hip fracture independent of cognitive function.
Databáze: OpenAIRE
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