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JAMA Intern Med. 2014 Aug;174(8):1273-80. doi: 10.1001/jamainternmed.2014.2362.

Survival and functional outcomes after hip fracture among nursing home residents.

Author information

1
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Leonard Davis Institute for Health Economics, the University of Pennsylvania, Philadelphia.
2
Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia2Leonard Davis Institute for Health Economics, the University of Pennsylvania, Philadelphia3Center for Outcomes Research, Children's.
3
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore.
4
Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia.
5
Department of Orthopedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
6
Leonard Davis Institute for Health Economics, the University of Pennsylvania, Philadelphia8Division of General Internal Medicine, Department of Internal Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.

Abstract

IMPORTANCE:

Little is known regarding outcomes after hip fracture among long-term nursing home residents.

OBJECTIVE:

To describe patterns and predictors of mortality and functional decline in activities of daily living (ADLs) among nursing home residents after hip fracture.

DESIGN, SETTING, AND PARTICIPANTS:

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.

MAIN OUTCOMES AND MEASURES:

Data sources included Medicare claims and the Nursing Home Minimum Data Set. 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.

RESULTS:

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. 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 (vs ≤75 years: hazard ratio [HR], 2.17; 95% CI, 2.09-2.26 [P < .001]), nonoperative fracture management (vs internal fixation: HR for death, 2.08; 95% CI, 2.01-2.15 [P < .001]), and advanced comorbidity (Charlson score of ≥5 vs 0: HR, 1.66; 95% CI, 1.58-1.73 [P < .001]). The combined risk of death or new total dependence in locomotion within 180 days was greatest among patients with very severe cognitive impairment (vs intact cognition: relative risk [RR], 1.66; 95% CI, 1.56-1.77 [P < .001]), patients receiving nonoperative management (vs internal fixation: RR, 1.48; 95% CI, 1.45-1.51 [P < .001]), and patients older than 90 years (vs ≤75 years: RR, 1.42; 95% CI, 1.37-1.46 [P < .001]).

CONCLUSIONS AND RELEVANCE:

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. Care planning should incorporate appropriate prognostic information related to outcomes in this population.

PMID:
25055155
PMCID:
PMC4122620
DOI:
10.1001/jamainternmed.2014.2362
[Indexed for MEDLINE]
Free PMC Article
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