Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort

Figures & data

Figure 1 Study flow chart of the case control study nested in a cohort of subjects with and without functionality.

Notes: *Patients who encountered difficulties for various reasons: clinical, paraclinical, or preoperative evaluations that interfered with measurements during hospitalization.

Abbreviation: IMSS, Mexican Institute of Social Security.

Table 1 Characteristics Studied and Strength of Association (Crude OR, 95% CI) with Functionality After Hip Fracture

Variable	Total n=346		Cases Functional n=173		Controls Non Functional n=173		p - value	ORc	95% CI	p - value
	n	(%)	n	(%)	n	(%)
Sex
Men	106	(30.6)	56	(32.4)	50	(28.9)	0.41	1.17	0.74–1.861	0.48
Women	240	(69.4)	117	(67.6)	123	(71.1)	0.58	1	-	-
Age (Years)
60–69	49	(14.2)	29	(16.8)	20	(11.6)	0.06	4.23	1.81–9.90	0.001
70–79	126	(36.4)	69	(39.9)	57	(32.9)	0.13	3.53	1.72–7.27	0.001
80–89	120	(34.7)	62	(35.8)	58	(33.5)	0.60	3.12	1.51–6.44	0.002
≥90	51	(14.7)	13	(7.5)	38	(22.0)	<0.001	1	-	-
Marital status
Has partner	129	(37.3)	64	(37.0)	65	(37.6)	0.90	0.97	0.63–1.508	0.91
No partner	217	(62.7)	109	(63.0)	108	(62.4)	0.92	1	-	-
Socioeconomic status
High	259	(74.9)	145	(83.8)	114	(65.9)	0.006	2.68	1.60–4.47	<0.001
Medium and low	68	(19.7)	28	(11.6)	59	(27.7)	<0.001	1	-	-
Employment status
Employed	71	(20.5)	49	(28.3)	22	(12.7)	<0.001	2.71	1.55–4.73	<0.001
Unemployed	275	(79.5)	124	(71.7)	151	(87.3)	0.021	1	-	-
Diabetes Mellitus type 2
Absent	221	(63.9)	102	(59.0)	119	(68.8)	<0.001	0.65	0.41–1.01	0.05
Present	125	(36.1)	71	(41.0)	54	(31.2)	0.032	1	-	-
Systemic arterial hypertension
Absent	137	(39.6)	71	(41.0)	66	(38.2)	0.54	1.12	0.73–1.737	0.58
Present	209	(60.4)	102	(59.0)	107	(61.8)	0.62	1	-	-
Osteoporosis
Absent	284	(82.1)	138	(79.8)	146	(84.4)	0.50	0.72	0.41–1.268	0.26
Present	62	(17.9)	35	(20.2)	27	(15.6)	0.15	1	-	-
History of Depression
Absent	325	(93.9)	165	(95.4)	160	(92.5)	0.69	1.67	0.67–4.151	0.26
Present	21	(6.1)	8	(4.6)	13	(7.5)	0.12	1	-	-
Osteoarthritis
Absent	296	(85.5)	150	(86.7)	146	(84.4)	0.72	1.20	0.66–2.200	0.54
Present	50	(14.5)	23	(13.3)	27	(15.6)	0.42	1	-	-
Cerebral Vascular Disease
Absent	329	(95.1)	170	(98.3)	159	(91.9)	0.39	4.99	1.40–17.68	0.013
Present	17	(4.9)	3	(1.7)	14	(8.1)	<0.001	1	-	-
Hemiplegia
Absent	336	(97.1)	171	(98.8)	165	(95.4)	0.64	4.14	0.86–19.81	0. 07
Present	10	(2.9)	2	(1.2)	8	(4.6)	0.007	1	-	-
Heart disease
Absent	312	(90.2)	165	(95.4)	147	(85.0)	0.15	3.64	1.60–8.30	0.002
Present	34	(9.8)	8	(4.6)	26	(15.0)	<0.001	1	-	-
Chronic kidney disease
Absent	332	(96.0)	168	(97.1)	164	(94.8)	0.75	1.84	0.60–5.619	0.28
Present	14	(4.0)	5	(2.9)	9	(5.2)	0.13	1	-	-
Chronic respiratory disease
Absent	312	(90.2)	158	(91.3)	154	(89.0)	0.74	1.30	0.63–2.65	0.47
Present	34	(9.8)	15	(8.7)	19	(11.0)	0.33	1	-	-
General morbidity
Low:<3 points	289	(83.5)	154	(89.0)	135	(78.0)	0.11	2.28	1.25–4.14	0.007
High:>3 points	57	(16.5)	19	(11.0)	38	(22.0)	<0.001	1	-	-
Functionality prior to the hip fracture
Functional (>90 points)	235	(67.9)	140	(80.9)	95	(54.9)	<0.001	3.48	2.14–5.64	<0.001
Non Functional (<90 points)	111	(32.1)	33	(19.1)	78	(45.1)	<0.001	1	-	-
Subcapital fracture
Present	34	(9.8)	17	(9.8)	17	(9.8)	1.0	1.00	0.49–2.03	1.0
Absent	312	(90.2)	156	(90.2)	156	(90.2)	1.0	1	-	-
Transcervical fracture
Present	56	(16.2)	34	(19.7)	22	(12.7)	0.023	1.67	0.93–3.01	0.08
Absent	290	(83.8)	139	(80.3)	151	(87.3)	0.31	1	-	-
Basicervical fracture
Present	29	(8.4)	16	(9.2)	13	(7.5)	0.43	1.25	0.58–2.69	0.56
Absent	317	(91.6)	157	(90.8)	160	(92.5)	0.81	1	-	-
Transtrochanteric fracture
Present	207	(59.8)	94	(54.3)	113	(65.3)	0.06	0.63	0.41–0.97	0.038
Absent	139	(40.2)	79	(45.7)	60	(34.7)	0.023	1	-	-
Subtrochanteric fracture
Present	20	(5.8)	12	(6.9)	8	(4.6)	0.20	1.53	0.61–3.86	0.36
Absent	326	(94.2)	161	(93.1)	165	(95.4)	0.75	1	-	-
Nutritional status
Normal (>24 points)	217	(62.7)	150	(86.7)	67	(38.7)	<0.001	10.31	6.04–17.61	<0.001
Nutritional risk/Malnutrition (≤24 points)	129	(37.3)	23	(13.3)	106	(61.3)	<0.001	1	-	-
Hip pain
No pain (0 points)	154	(44.4)	88	(50.9)	66	(38.2)	0.012	3.75	1.76–8.02	0.001
Low(1–3 points)	80	(23.1)	44	(25.4)	36	(20.8)	0.20	3.44	1.52–7.79	0.003
Moderate (4–7 points)	70	(20.2)	30	(17.3)	40	(23.1)	0.09	2.11	0.91–4.87	0.07
High (8–10 points)	42	(9.2)	11	(6.4)	31	(17.9)	<0.001	1	-	-
Rehabilitation time
≥ 1 month	57	(16.5)	39	(22.5)	18	(10.4)	<0.001	2.50	1.36–4.58	0.003
< 1 month	289	(83.5)	134	(77.5)	155	(89.6)	0.08	1	-	-
Social support
High (>57 points)	118	(34.1)	68	(39.3)	50	(28.9)	0.019	2.61	1.53–4.45	<0.001
Moderate (44–56 points)	114	(32.9)	66	(38.2)	48	(27.7)	0.017	2.64	1.54–4.52	<0.001
Low (<43 points)	114	(32.9)	39	(22.5)	75	(43.4)	<0.001	1	-	-
Loneliness
Never (<20 points)	236	(68.2)	131	(75.7)	105	(60.7)	0.017	2.91	0.73–11.53	0.12
Rarely (20–39 points)	69	(19.9)	28	(16.2)	41	(23.7)	0.027	1.59	0.37–6.69	0.52
Sometimes (40–59 points)	31	(9.0)	11	(6.4)	20	(11.6)	0.022	1.28	0.27–5.98	0.75
Most of the time (>60 points)	10	(2.9)	3	(1.7)	7	(4.0)	0.07	1	-	-
Current depressive symptoms
Absent	191	(55.2)	129	(74.6)	62	(35.8)	<0.001	5.24	3.30–8.33	<0.001
Present	155	(44.8)	44	(25.4)	111	(64.2)	<0.001	1	-	-
Cognitive function
No cognitive impairment	232	(67.1)	134	(77.5)	98	(56.6)	0.001	2.63	1.64–4.19	<0.001
Cognitive impairment	114	(32.9)	39	(22.5)	75	(43.4)	<0.001	1	-	-
Self-efficacy for activities of daily living
High (≥57 points)	221	(63.9)	150	(86.7)	71	(41.0)	<0.001	9.36	5.49–15.97	<0.001
Moderate and Low (<57 points)	125	(36.1)	23	(13.3)	102	(59.0)	<0.001	1	-	-
Self-perception of health
Very good	49	(14.2)	33	(19.1)	16	(9.2)	0.001	7.42	3.41–16.13	<0.001
Good	108	(31.2)	75	(43.4)	33	(19.1)	<0.001	8.18	4.30–15.55	<0.001
Poor	97	(28.0)	45	(26.0)	52	(30.1)	0.31	3.11	1.64–5.88	<0.001
Very poor	92	(26.6)	20	(11.6)	72	(41.6)	<0.001	1	-	-
Fear of falling
Low (≤44 points)	114	(32.9)	77	(44.5)	37	(21.4)	<0.001	4.33	2.48–7.57	<0.001
Moderate (45–55 points)	121	(35.0)	60	(34.7)	61	(35.3)	0.89	2.04	1.20–3.49	0.008
High (≥56 points)	111	(32.1)	36	(20.8)	75	(43.4)	<0.001	1	-	-

Abbreviations: ORc, crude odds ratio; CI, confidence interval.

Table 2 Multivariate Logistic Regression Model of the Strength of Association (Adjusted OR, 95% CI) with Functionality After Hip Fracture

Variable	β	Standard Error	Wald	OR	95% CI	p - value
Constant	− 5.37	0.71	55.82	0.005	-	< 0.001
Nutritional status
Normal (>24 points)	1.573	0.326	23.312	4.81	2.54–9.12	< 0.001
Nutritional risk/Malnutrition (≤24 points)				Ref.
Heart disease
Absent	1.407	0.515	7.465	4.08	1.48–11.20	0.006
Present				Ref.
Self-efficacy for activities of daily living
High (≥57 points)	1.405	0.326	18.553	4.07	2.15–7.72	< 0.001
Moderate and Low (<57 points)				Ref.
Current depressive symptoms
Absent	1.097	0.290	14.302	2.99	1.69–5.28	< 0.001
Present				Ref.
Functionality prior to the hip fracture
Functional (>90 points)	1.042	0.321	10.555	2.83	1.51–5.31	0.001
Non Functional (<90 points)				Ref.
Socioeconomic level
High	0.880	0.336	6.870	2.41	1.24–4.65	0.009
Moderate and low				Ref.
Transcervical
Present	0.852	0.409	4.329	2.34	1.05 −5.22	0.037
Absent				Ref.

Abbreviations: OR, odds ratio; CI, confidence interval.