Cognitive Impairment As the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People

Overview

Journal Prog Rehabil Med

Specialty Rehabilitation Medicine

Date 2022 May 31

PMID 35633759

Authors

Teruhito Yoshitaka

Yasunori Shimaoka

Issei Yamanaka

Akira Tanida

Junichi Tanimoto

Naoki Toda

Taro Akimori

Junichi Hamawaki

Affiliations

Soon will be listed here.

Abstract

Objectives: Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment.

Methods: A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables.

Results: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2-3 weeks postoperatively compared with those with an MMSE score of ≥21.

Conclusion: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.

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References

Folstein M, Folstein S, McHugh P . "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975; 12(3):189-98. DOI: 10.1016/0022-3956(75)90026-6. View

Benedetti M, Ginex V, Mariani E, Zati A, Cotti A, Pignotti E . Cognitive impairment is a negative short-term and long-term prognostic factor in elderly patients with hip fracture. Eur J Phys Rehabil Med. 2015; 51(6):815-23. View

Perneczky R, Wagenpfeil S, Komossa K, Grimmer T, Diehl J, Kurz A . Mapping scores onto stages: mini-mental state examination and clinical dementia rating. Am J Geriatr Psychiatry. 2006; 14(2):139-44. DOI: 10.1097/01.JGP.0000192478.82189.a8. View

Coster W, Haley S, Jette A . Measuring patient-reported outcomes after discharge from inpatient rehabilitation settings. J Rehabil Med. 2006; 38(4):237-42. DOI: 10.1080/16501970600609774. View

Ariza-Vega P, Lozano-Lozano M, Olmedo-Requena R, Martin-Martin L, Jimenez-Moleon J . Influence of Cognitive Impairment on Mobility Recovery of Patients With Hip Fracture. Am J Phys Med Rehabil. 2016; 96(2):109-115. DOI: 10.1097/PHM.0000000000000550. View

Bergstrom U, Jonsson H, Gustafson Y, Pettersson U, Stenlund H, Svensson O . The hip fracture incidence curve is shifting to the right. Acta Orthop. 2009; 80(5):520-4. PMC: 2823331. DOI: 10.3109/17453670903278282. View

Muir S, Gopaul K, Montero Odasso M . The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing. 2012; 41(3):299-308. DOI: 10.1093/ageing/afs012. View

Bliemel C, Lechler P, Oberkircher L, Colcuc C, Balzer-Geldsetzer M, Dodel R . Effect of Preexisting Cognitive Impairment on In-Patient Treatment and Discharge Management among Elderly Patients with Hip Fractures. Dement Geriatr Cogn Disord. 2015; 40(1-2):33-43. DOI: 10.1159/000381334. View

Yoshii I, Satake Y, Kitaoka K, Komatsu M, Hashimoto K . Relationship between dementia degree and gait ability after surgery of proximal femoral fracture: Review from Clinical Pathway with Regional Alliance data of rural region in Japan. J Orthop Sci. 2016; 21(4):481-486. DOI: 10.1016/j.jos.2016.03.005. View

10.

Alexander M . Stroke rehabilitation outcome. A potential use of predictive variables to establish levels of care. Stroke. 1994; 25(1):128-34. DOI: 10.1161/01.str.25.1.128. View

11.

Adunsky A, Lusky A, Arad M, Heruti R . A comparative study of rehabilitation outcomes of elderly hip fracture patients: the advantage of a comprehensive orthogeriatric approach. J Gerontol A Biol Sci Med Sci. 2003; 58(6):542-7. DOI: 10.1093/gerona/58.6.m542. View

12.

Tombaugh T, McIntyre N . The mini-mental state examination: a comprehensive review. J Am Geriatr Soc. 1992; 40(9):922-35. DOI: 10.1111/j.1532-5415.1992.tb01992.x. View

13.

Anthony J, LeResche L, Niaz U, Von Korff M, Folstein M . Limits of the 'Mini-Mental State' as a screening test for dementia and delirium among hospital patients. Psychol Med. 1982; 12(2):397-408. DOI: 10.1017/s0033291700046730. View

14.

Bellelli G, Frisoni G, Pagani M, Magnifico F, Trabucchi M . Does cognitive performance affect physical therapy regimen after hip fracture surgery?. Aging Clin Exp Res. 2007; 19(2):119-24. DOI: 10.1007/BF03324677. View

15.

Omsland T, Emaus N, Tell G, Magnus J, Ahmed L, Holvik K . Mortality following the first hip fracture in Norwegian women and men (1999-2008). A NOREPOS study. Bone. 2014; 63:81-6. DOI: 10.1016/j.bone.2014.02.016. View

16.

Kwon S, Hartzema A, Duncan P, Min-Lai S . Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke. 2004; 35(4):918-23. DOI: 10.1161/01.STR.0000119385.56094.32. View

17.

Arvanitakis Z, Shah R, Bennett D . Diagnosis and Management of Dementia: Review. JAMA. 2019; 322(16):1589-1599. PMC: 7462122. DOI: 10.1001/jama.2019.4782. View

18.

Tsuji T, Sonoda S, Domen K, Saitoh E, Liu M, Chino N . ADL structure for stroke patients in Japan based on the functional independence measure. Am J Phys Med Rehabil. 1995; 74(6):432-8. DOI: 10.1097/00002060-199511000-00007. View

19.

Neuman M, Silber J, Magaziner J, Passarella M, Mehta S, Werner R . Survival and functional outcomes after hip fracture among nursing home residents. JAMA Intern Med. 2014; 174(8):1273-80. PMC: 4122620. DOI: 10.1001/jamainternmed.2014.2362. View

20.

Veronese N, Maggi S . Epidemiology and social costs of hip fracture. Injury. 2018; 49(8):1458-1460. DOI: 10.1016/j.injury.2018.04.015. View