Article

PURPOSE: To examine factors associated with changes in mobility and living
arrangements in a comprehensive geriatric outpatient assessment after hip
fracture. METHOD: Population-based prospective data on 887 consecutive hip
fracture patients aged 65 years and older.
The domains of the geriatric
assessment were the independent and changes in mobility level and living
arrangements 4 months postoperatively the outcome variables. RESULTS: Of the
survivors, 499 (73%) attended the assessment. The mobility level had declined in
39% of the attendees and 38% of them had moved to more supported living
arrangements 4 months after the hip fracture. In the age-adjusted univariate
logistic regression analyses, almost all the domains of the comprehensive
geriatric assessment were significantly associated with both outcomes. In the
forward stepwise multivariate analysis, disability in activities of daily living,
poor performance in Timed Up and Go and comorbidity as measured by the American
Society of Anesthesiologists scores remained significantly associated with the
outcomes. CONCLUSIONS: While comorbidity and disability in activities of daily
living and mobility are the major indicators of poor outcomes of mobility and
living arrangements after hip fracture, all the domains in the comprehensive
geriatric assessment deserve attention during hip fracture care and
rehabilitation. Implications for Rehabilitation In almost half of the patients
the mobility level and living arrangements had deteriorated
4 months after the
hip fracture, suggesting an urgent need for more effective postoperative
rehabilitation. Almost all the domains of the comprehensive geriatric assessment
were associated with poor outcomes and require equal attention during the acute
and postacute phases of hip fracture care and in the course of rehabilitation. A geriatric outpatient assessment a few months after the hip fracture provides a
check-point for the outcomes and an opportunity to target interventions at
different domains of the comprehensive assessment.

Langue : ANGLAIS