19 Hip Fracture Outcomes in the Frail Older Person. (16th September 2019)

• Record Type: Journal Article
• Authors: Small, Cliona; Kneafsey, Sian; McFeely, Aoife; O'Hanlon, Shane; Cooney, Marie Therese; Doyle, Rachael
• Is Part Of: Age and ageing. Volume 48(2019)Supplement 3
• Page Start: iii17
• Page End: iii65
• Publication Date: 2019-09-16
• Subjects: Aging -- Periodicals; Geriatrics -- Periodicals; 618.97
• DOI: 10.1093/ageing/afz103.11
• Languages: English
• ISSNs: 0002-0729

Abstract

Abstract: Background: Hip fractures in the older person are associated with significant morbidity and mortality. Screening patients for frailty and assessing baseline mobility and function may help predict poorer outcomes Methods: All patients >/= 60 years old with a hip fracture admitted under the orthopaedic team between February 2016-February 2018 were included. We assessed clinical frailty score(CFS), zuckermann functional recovery score(FRS) and new mobility score(NMS) on admission and at 1 year. Outcomes assessed included mortality rates and nursing home(NH) admission rates Results: 541 patients were included; 533 underwent surgery, 4 died preoperatively and 4 of the periprosthetic fracture cohort were treated conservatively. 33 patients lost to follow-up. Overall mortality was 24.7%(n=134) at one year. In the severely frail cohort (CFS7-9)(n=72); 47.2% mortality rate at 1 year. 20.8%(n=15) came from home, 2 of those were discharged to NH. In the moderately frail cohort (CFS 5-6)(n= 184), mortality rate was 30.4% at 1 year. 77.2%(n=142) were admitted from home and 8%(n=15) of this cohort were discharged to NH. In the non-frail subgroup (CFS 1-4)(n=211), mortality rate was 11.8%(n= 25)at 1 year, 97.1% (n=205) were admitted from home and 7.5%(n=11) of the cohort admitted from home were living in a NH at 1 year. Regarding FRS; compared to those without frailty(FRS>75), those with FRS 30-75 had a two-fold increased risk of one year mortality [OR: 2.16 (95% CI: 1.24 to 3.78)]. This increased to a nearly six-fold increased risk in those with severe frailty (FRS<30); [OR 5.73 (95%CI : 3.16 -10.41)]. This effect was independent of age. A dementia diagnosis independent of age and frailty is associated with 2.5 fold increased risk of NH/mortality at 1 year Conclusion: All three tools (CFS, NMS, FRS) can accurately predict mortality and NH admission at 1 year. Patients with higher CFS and poor baseline functioning and mobility have poorer outcomes. CFS is a simple tool that can be documented on admission with a hip fracture and help inform discussions with patients and families regarding potential outcomes/prognosis.