Low admission Norton scale scores are associated with falls long after rehabilitation in the elderly with hip fractures

Figures & data

Table 1 Clinical characteristics of the cohort

Comorbidities	Whole cohort (n = 174)	Surviving patients (n = 127)	P value
Hypertension, n (%)	131 (75.3)	94 (74.0)	0.893
Diabetes mellitus, n (%)	38 (28.1)	27 (21.3)	0.999
Ischemic heart disease, n (%)	35 (20.1)	23 (18.1)	0.768
Pressure ulcer, n (%)	24 (13.8)	18 (14.2)	0.999
Stroke, n (%)	20 (11.5)	13 (10.2)	0.852
Parkinson’s disease, n (%)	10 (5.7)	5 (3.9)	0.596
Albumin levels, Mean ± SD, mg%	33.4 ± 3.4	36.7 ± 3.6	0.747
MMSE scores, Mean ± SD	23.2 ± 5.8*	24.1 ± 5.5**	0.295
During follow-up
Falls, n (%)	NA***	44 (34.6)	NA
Falls, Mean ± SD	NA***	0.8 ± 1.8	NA
Recent falls, Mean ± SD	NA***	0.4 ± 1.0	NA
Secondary fractures, n (%)	NA***	15 (11.8)	NA
Hospitalizations, Mean ± SD	NA***	0.6 ± 1.1	NA
Death, n (%)	47 (27.0)	NA	NA

Notes:

* Data available for 109 patients;

** data available for 82 patients;

*** data was not available for deceased patients.

Abbreviations: MMSE, Mini-mental state examination; NA, not applicable; SD, standard deviation.

Table 2 Characteristics of patients with low and high admission Norton scale scores

	High ANSS (n = 93)	Low ANSS (n = 81)	OR (95% CI)	P value
Demographics and comorbidities
Age, mean ± SE, years	82.1 ± 6.3	85.4 ± 5.6	NA	<0.0001
Female gender, n (%)	69 (74.2)	64 (79.0)	1.3 (0.6–2.7)	0.479
Hypertension, n (%)	66 (70.9)	65 (80.2)	1.6 (0.8–3.4)	0.164
Diabetes mellitus, n (%)	20 (21.5)	18 (22.2)	1.0 (0.5–2.1)	0.999
Ischemic heart disease, n (%)	15 (16.1)	20 (24.7)	1.7 (0.8–3.6)	0.187
Pressure ulcer, n (%)	11 (11.8)	13 (16.0)	1.4 (0.6–3.4)	0.510
Stroke, n (%)	11 (11.8)	9 (11.1)	0.9 (0.4–2.4)	0.999
Parkinson’s disease, n (%)	3 (3.2)	7 (8.6)	2.8 (0.7–11.4)	0.191
Albumin levels, mean ± SE, mg%	34.1 ± 3.5	32.5 ± 3.2	NA	0.002
MMSE scores*, mean ± SE	24.9 ± 4.8	21.4 ± 6.2	NA	0.001
During follow-up
Falls**, n (%)	17 (18.3)	27 (33.3)	3.3 (1.5–7.1)	0.002
Falls**, mean ± SE	0.6 ± 1.7	1.2 ± 1.8	NA	0.002
Recent falls**, mean ± SE	0.4 ± 1.2	0.5 ± 0.8	NA	0.086
Secondary fractures**, n (%)	9 (9.7)	6 (7.4)	0.9 (0.3–2.7)	0.999
Hospitalizations**, mean ± SE	0.4 ± 1.0	0.7 ± 1.1	NA	0.106
Death, n (%)	20 (21.5)	27 (33.3)	1.8 (0.9–3.6)	0.089

Notes:

* Data available for 109 patients;

** data available for 127 patients who did not die.

Abbreviations: ANSS, admission Norton scale scores; CI, confidence interval; MMSE, Mini-mental state examination; NA, not applicable; OR, odds ratio; SE, standard error.

Figure 1 Pearson’s correlation between admission Norton scale scores and the number of falls.

Table 3 Regression analysis showing which variables were independently associated with falls*

	OR	95% CI		P value
		Lower boundary	Upper boundary
Independent variables
Age	1.011	0.913	1.120	0.835
Female gender	2.214	0.443	11.064	0.333
Hypertension	0.297	0.075	1.176	0.084
Diabetes mellitus	0.496	0.132	1.863	0.299
Ischemic heart disease	0.955	0.167	5.467	0.958
Pressure ulcer	0.097	0.008	1.213	0.070
Stroke	0.382	0.041	3.594	0.400
Parkinson’s disease	2.899	0.130	64.461	0.501
ORIF	0.380	0.116	1.242	0.109
Albumin levels	1.053	0.899	1.233	0.523
MMSE scores	1.037	0.929	1.156	0.519
Low ANSS (nonparametric)	5.133	1.513	17.411	0.009
Independent variables
Age	1.003	0.906	1.111	0.948
Female gender	2.210	0.425	11.498	0.346
Hypertension	0.243	0.059	1.001	0.050
Diabetes mellitus	0.469	0.121	1.815	0.273
Ischemic heart disease	1.501	0.233	9.694	0.669
Pressure ulcer	0.067	0.005	0.969	0.047
Stroke	0.432	0.047	3.947	0.457
Parkinson’s disease	2.662	0.098	72.619	0.562
ORIF	0.381	0.113	1.285	0.120
Albumin levels	0.975	0.822	1.157	0.770
MMSE scores	1.022	0.914	1.142	0.703
ANSS (parametric)	1.906	1.272	2.856	0.002

Note:

* Data available for 82 patients.

Abbreviations: ANSS, admission Norton scale scores; CI, confidence interval; MMSE, Mini-mental state examination; OR, odds ratio; ORIF, open reduction and internal fixation.

Appendix Norton scoring system

Domains	Scores
Physical condition	4 = Good
	3 = Fair
	2 = Poor
	1 = Very bad
Mental condition	4 = Alert
	3 = Apathetic
	2 = Confused
	1 = Stuporous
Activity (in daily living)	4 = Independent
	03 = Slightly dependent
	2 = Very dependent
	1 = Fully dependent
Mobility	4 = Ambulant
	3 = Walks with help
	2 = Chair bound
	1 = Bedridden
Incontinence	4 = None
	3 = Occasional
	2 = Usually urinary
	1 = Urinary and fecal