Can hip-fractured elderly patients maintain their rehabilitation achievements after 1 year?

Abstract

Purpose: The purpose of this study is to characterize hip-fractured patients who maintained or improved their functional ability, 1 year postdischarge from rehabilitation and to identify factors associated with functional achievement maintenance. Methods: A retrospective study performed in a postacute geriatric rehabilitation center. Two hundred thirty-three hip-fractured patients admitted consecutively from January 2006 to September 2007 were enrolled in the study. The patients were evaluated at discharge from rehabilitation and after 1 year, they were classified into two groups: those who maintained or improved their motor Functional Independence Measure (mFIM) scores and those who deteriorated. The differences between the two patient groups relating to functional, clinical, demographic and fracture-related variables were assessed. Results: One year postrehabilitation, 130 (55.8%) patients exhibited a decline in their mFIM score. Patients whose 1-year mFIM score had improved were discharged from rehabilitation with a less favorable mean mFIM score (50.7 ± 18.5 vs. 55.6 ± 15.2; p = 0.032), achieved a lower mean mFIM score gain during rehabilitation (12.0 ± 9.7 vs. 14.6 ± 8.1; p = 0.03), had a higher education level (p = 0.003) and had a lower rate of chronic lung disease (p = 0.020) compared with patients whose 1-year mFIM score had deteriorated. After 1 year, only 21 patients (9%) were functionally independent in activities of daily living and only 19 (8.2%) were able to walk unassisted. Only 13 patients (5.6%) perceived that they had regained their former functional level. Conclusions: A substantial decline in functional ability of hip-fractured patients occurred 1 year postdischarge from rehabilitation. Healthcare providers should be aware of the necessity for a long-term postrehabilitation physical training program to prevent functional decline. Further efforts should be invested in motivating their patients to exercise.

Implications for Rehabilitation

• A considerable decline in functional level occurs in elderly following hip fracture after discharge from post-acute rehabilitation program.

• Functional deterioration is more noticeable among patients who achieved higher functional performance during rehabilitation.

• To slow down functional decline, providing continuous physical training to hip-fractured elderly patients after discharge from rehabilitation is recommended.

Keywords::

• Elderly
• functional recovery
• hip fractures
• outcomes

Acknowledgments

The authors thank Mrs. Ilana Gelernter, MA (Department of Statistics, Tel Aviv University) for assistance with data analysis and Mrs. Phyllis Curchack Kornspan for her editorial services.

Declaration of interest: This study received a grant from the Ministry of Health #3-5880.