Sensory impairment in hip-fracture patients 65 years or older and effects of hearing/vision interventions on fall frequency

Figures & data

Figure 1 Flow chart showing the number of interventions and controls at time of inclusion and follow-up periods and the inclusion and exclusion criteria.

Table 1 Characteristics of participants at baseline given as number of cases (%), unless otherwise stated, with P values for group differences

Characteristics	All n = 331	Intervention n = 200	Control n = 131	P value
Age (years), mean (min, max)	84.2 (65, 100)	84.4 (65, 98)	84.1 (66, 100)	0.765
Gender (female)	264 (79.8)	168 (84.0)	96 (73.3)	0.018
Living alone	254 (76.7)	163 (81.5)	91 (69.5)	0.011
Vision impairment	198 (59.8)	108 (54.0)	90 (68.7)	0.008
Hearing impairment	267 (80.7)	161 (80.5)	106 (80.9)	0.925
Vision and hearing impairment	134 (40.5)	69 (34.5)	65 (49.6)	0.006
Delirium, score 0–8 (score 8)	50 (15.1)	20 (10.0)	30 (22.9)	0.02
Cognitive impairment, CPS a0–6 (score > 0)	160 (48.3)	98 (49.0)	62 (47.3)	0.766
Discouraged, score mood/behavior 0–6 (score 6)	64 (19.3)	52 (26.0)	12 (9.2)	<0.001
PADLb loss, PADLHierScale 0–6 (score ≥ 4)	184 (55.6)	111 (55.5)	73 (55.7)	0.968
IADLc loss, Involvement Scale 0–21 (score ≥ 4)	169 (51.1)	104 (52.0)	65 (49.6)	0.672
Urine incontinence	163 (49.2)	114 (57.0)	49 (37.4)	<0.001
Severe pain, score 0–3 (score 3)	145 (43.8)	71 (35.5)	74 (56.5)	<0.001
Underweight (BMId < 20)	79 (23.9)	51 (25.5)	28 (21.4)	0.389
Obese (BMI ≥ 30)	15 (4.5)	11 (5.5)	4 (3.1)	0.295
Unintended weight loss (5% last 30 d)	54 (16.3)	35 (17.5)	19 (14.5)	0.471
Polypharmacy (number of drugs ≥ 6)	180 (54.4)	105 (52.5)	75 (57.3)	0.396
Comorbidity (number of ICDe−10 ≥ 2)	268 (8.0)	160 (80.0)	108 (82.4)	0.580
LOSf days, median (min, max)	11 (2, 110)	11 (4, 71)	10 (2, 110)	0.301

Notes:

a Cognitive Performance Scale,

b Personal Activities of Daily Living,

c Instrumental Activities of Daily Living,

d Body Mass Index,

e International Classification of Diseases,

f Length of Stay.

Table 2 Self-reported characteristics of participants at baseline given as number of cases (%), unless otherwise stated, with P values for group differences

Characteristics	All n = 331	Intervention n = 200	Control n = 131	P value
Cataract	103 (32.9)	71 (35.5)	32 (28.3)	0.033
AMD	41 (12.4)	24 (12.0)	17 (13.0)	0.792
Glaucoma	64 (19.3)	42 (21.0)	22 (16.8)	0.343
Glasses used daily	226 (68.3)	146 (73.0)	80 (61.1)	0.023
Vision remedies	101 (30.5)	73 (36.5)	28 (21.4)	0.003
>2 years since last vision check	137 (41.4)	85 (42.5)	52 (39.7)	0.612
Hearing loss, age related	241 (72.89	177 (88.5)	64 (48.9)	<0.0001
Hearing loss, disease related	21 (6.3)	18 (9.0)	3 (2.3)	0.014
Hearing loss, noise/medication related	14 (4.2)	4 (2.0)	10 (7.6)	0.013
Hearing aid used daily	53/115 (46.1)	27/70 (38.6)	26/45 (57.8)	0.044
Hearing remedies, including warning	64 (19.3)	44 (22.0)	20 (15.3)	0.129
>2 years since last hearing check	245 (78.5)	159 (79.5)	86 (76.8)	0.575

Table 3 Outcomes given as number of cases (%), unless otherwise stated, with odds ratio (OR) and 95% confidence interval (CI) and P values for group differences

Outcomes	All n = 331	Intervention n = 200	Controls n = 131	OR	95% CI	P value
Dead	52 (15.7)	34 (17.0)	18 (13.7)	1.3	0.7–2.4	0.425
Nursing home	67 (20.2)	53 (26.5)	14 (10.7)	3.0	1.6–5.7	<0.001
Living alone, n = 264	195 (73.9)	114 (77.6)	81 (69.2)	0.7	0.4–1.1	0.126
Readmitted to hospital, n = 326	139 (42.0)	83 (42.1)	56 (43.4)	0.9	0.6–1.5	0.819
Falls
Patients who have fallen	146 (44.1)	102 (51.0)	44 (33.6)	2.0	1.3– 3.2	0.002
Patients who have fallen ≥2	85 (25.7)	59 (29.5)	26 (19.8)	1.7	1.0–2.9	0.049
Falls (mean/SD)	433 (1.3/2.5)	310 (1.6/2.6)	123 (0.9/2.2)		−1.1– −0.1	0.026
Median no. of falls/min-max	0/0–17	1/0–17	0/0–15
Patients with fall injury	60 (41.1)	42 (41.2)	18 (40.9)	1.0	0.5–2.1	0.976
Patients falling indoors, n = 146	117 (80.1)	83 (81.4)	34 (77.3)	1.3	0.5–3.0	0.569
Activity level
<1 hour activity last 3 days	110 (33.2)	60 (30.0)	50 (38.2)	0.7	0.4–1.1	0.123
Assistance when climbing stairs	149 (45)	101 (50.5)	48 (36.6)	1.8	1.1–2.8	0.013
Assistance, walking device, indoors	217 (65.6)	136 (68.0)	81 (61.8)	1.3	0.8–2.1	0.248
Assistance when going outdoors	174 (52.6)	108 (54.0)	66 (50.4)	1.2	0.7–1.8	0.519
Indoors last 3 days	145 (43.8)	88 (44.0)	57 (43.5)	1.0	0.7–1.6	0.930
Assistance getting up after falling	113 (77.4)	79 (77.5)	34 (77.1)	1.0	0.4–2.3	0.981
Specialist assessment/treatment
Physiotherapy	179 (54.1)	114 (57.0)	65 (49.6)	1.3	0.9–2.1	0.188
Hearing specialist assessment	86 (26.0)	72 (36.0)	14 (10.7)	4.7	2.5–8.8	<0.0001
Hearing aid, new/upgraded	46 (14.6)	39 (20.2)	7 (5.8)	4.1	1.8–9.6	<0.0001
Hearing remedies, new/upgraded	30 (9.1)	29 (14.5)	1 (0.8)
Vision specialist assessment	140 (42.3)	92 (46.0)	48 (36.6)	1.5	0.9–2.3	0.092
Operation, new eye medication	23 (6.9)	20 (10.0)	3 (2.3)
Glasses, vision remedies	55 (16.6)	44 (22.0)	11 (8.4)	3.1	1.5–6.2	0.001

Figure 2 Kaplan–Meier curves presenting time to first fall for the intervention group (n = 200 participants) versus the control group (n = 131 participants) controlled for by age, gender, delirium, and urine incontinence.

Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval for OR; P, P value.

Figure 3 Kaplan–Meier curves presenting time to first fall of persons who received sensory treatment versus persons who did not, controlled for by age, gender, delirium, and urine incontinence. Sensory treatment group, n = 117; nonsensory treatment group, n = 214.

Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval for OR; P, P value.