Cognitive Differences Between Men and Women Who Fracture Their Hip and Impact on Six-Month Survival

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2017 Feb 9

PMID 28176306

Citations 13

Authors

Ann L Gruber-Baldini

Mina Hosseini

Denise Orwig

Lynn Grattan

Nancy Chiles Shaffer

Marc Hochberg

Jay Magaziner

Affiliations

Soon will be listed here.

Abstract

Objectives: There is limited research in cognition and its relationship to mortality after hip fracture among men compared to women. Therefore, the goals of this study were to: (1) compare men and women who fractured their hip on cognition after hospital discharge, and (2) examine the impact of cognition on the differential risk of 6-month mortality between men and women post fracture.

Design: Prospective cohort study.

Setting: Eight hospitals in Baltimore, Maryland.

Participants: Frequency matched 168 male and 171 female hip fracture patients, ages 65 or older, living in the community before fracture.

Measurements: Cognition assed by Modified Mini-Mental State Examination (3MS, and derived MMSE score), Hooper Visual Organization test (HVOT), and Trail-making test (Trails A & B) within 22 days of hospital admission, and 6-month mortality.

Results: Men had more impaired cognitive scores on 3MS, MMSE, HVOT, and Trails A (P < .05) at baseline. These statistically significant differences between men and women remained on MMSE and HVOT after controlling for pre-fracture dementia, in-hospital delirium, age, education, race, and comorbidity. Men had higher 6-month mortality rates (HR = 4.4, P < .001). Cognitive measures were also significantly associated with mortality, including 3MS, HVOT, and Trails B. Among the cognitive measures, higher 3MS was most protective for mortality (HR = 0.98, P < .001), both unadjusted and adjusted for other cognitive scales, comorbidity, delirium, and pre-existing dementia. The highest mortality was among men with 3MS<78, with 26.3% dying within 6 months. The effects of cognition on mortality did not differ by sex.

Conclusion: Men display greater levels of cognitive impairment within the first 22 days of hip fracture than women, and cognitive limitations increase the risk of mortality in both men and women.

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