Factors affecting mortality of frail hip-fractured elderly patients

Abstract 

Hip fracture in the elderly may lead to increased morbidity and mortality. We assessed factors affecting mortality of frail elderly hip-fractured patients during the first 2 years after discharge from a post-acute rehabilitation program. Included were 376 patients admitted from 1/2006 to 9/2007. Kaplan–Meier curves were used for survival analysis. During the 2 years after discharge 68 patients (20.8%) died. Sex, fracture type, operation versus conservative treatment, time to surgical intervention, presence of depression, impaired neurological function or comorbidity burden were not found to be significant predictors of mortality. Comparisons of survival curves showed significantly higher mortality in patients with admission albumin level of <3.5g/dl compared to patients with levels of ≥3.5g/dl (p=0.017); demented versus cognitively intact patients (p<0.001); patients with admission FIM score of <40 versus those with scores of 40–79 and ≥80 (p=0.012); very old patients (>84) compared with old (75–84) and young-old patients (<75) (p=0.003). Multivariate analysis showed that only dementia and age were independent predictors of mortality in the studied group. Multidisciplinary teams should be aware of treatable variables affecting these patients’ survival and should endeavor to improve their functional and nutritional level. Moreover, expectation coordination should be carried out with very old and cognitively impaired patients.

Keywords: Hip fracture, Older people, Rehabilitation, Mortality, Survival curves