Does anatomical type of proximal hip fracture affect rehabilitation outcomes among older adults?

BACKGROUND AND PURPOSE: Numerous studies have detailed the potential benefits of inpatient geriatric rehabilitation for older adults with hip fractures. However, data regarding effect of fracture type (femoral neck, intertrochanteric, or subtrochanteric) on rehabilitation outcomes are limited. This study assessed whether the anatomical type of proximal hip fracture affects rehabilitation outcomes among disabled older adults. METHODS: A population-based study was conducted comparing all patients with a recent hip fracture who were admitted to a geriatric rehabilitation facility in Israel. Data were collected retrospectively from an electronic database during a 5-year period (2014-2019). The Functional Independence Measure (FIM) was used to assess physical and cognitive function at admission and discharge. RESULTS: The analyses included 624 older adults with hip fractures. We found significant differences in motor FIM score at admission, as patients with femoral neck fracture performed better than patients with intertrochanteric and subtrochanteric fracture did. The disparity in motor FIM score remained consistent through discharge, with all groups achieving a median gain of 14 points. Within one month of rehabilitation, about a third of all patients achieved a higher functional level. CONCLUSIONS: Patients with femoral neck fracture have better motor ability than do those with intertrochanteric and subtrochanteric fractures, which were retained throughout the course of rehabilitation; yet, the level of improvement remained similar. Clinicians should be aware of such differences in functional ability when discussing goals of care with older adults with hip fractures and consider them when implementing individual rehabilitation programs .

Vitamin D levels in post-acute hip fractured patients and their association with rehabilitation outcomes.

PURPOSE: To report on serum 25-hydroxyvitamin D (25(OH)D) levels in post-acute hip fractured patients, revealed the associations between serum 25(OH)D levels and hip fractured patients' baseline characteristics and rehabilitation outcomes. MATERIALS AND METHODS: A retrospective study (9/2017-9/2020) of 493 hip fractured patients. 25(OH)D levels were recorded following the patient's baseline characteristics and outcome measures, including the functional independence measure and motor functional independence measure effectiveness. The sample was divided into three groups: deficient (<30 nmol/l), insufficient (30-75 nmol/l) and sufficient (>75 nmol/l) 25(OH)D levels. ANOVA and chi-square test tests compared the groups. Multiple linear analysis assessed the associations between the 25(OH)D and discharge functional independence measure score. RESULTS: 25(OH)D deficiency was found in 20.3% of the patients. The only baseline characteristic significantly associated with serum 25(OH)D levels was dementia. The group with deficient levels of 25(OH)D exhibited a significantly higher rate of low education, low admission albumin levels and a reduced handgrip strength compared to the insufficient/sufficient groups. All functional measure scores were significantly lower in the deficient (25(OH)D) group compared with the insufficient/sufficient patient groups. 25(OH)D levels were found to be significantly associated with the discharge functional independence measure score. CONCLUSIONS: Routine screening for 25(OH)D levels is mandatory in post-acute hip fracture patients as it may affect rehabilitation outcomes.Implications for Rehabilitation25-hydroxyvitamin D 25(OH)D levels are associated with rehabilitation outcomes in post-acute hip fractured patients.A routine screening for 25(OH)D levels and standardized supplementation protocol during the acute and post-acute rehabilitation setting is recommended as it may improve the quality of care.

Post-hip fracture rehabilitation outcomes of diabetic and non-diabetic elderly patients.

BACKGROUND: Although patients with diabetes mellitus (DM) are at higher risk of hip fracture, data regarding the effect of DM on rehabilitation outcomes are limited. METHODS: A retrospective single-centre study was conducted comparing elderly diabetic and non-diabetic patients with recent hip fracture, admitted to geriatric rehabilitation, 2014-2019. The functional independence measure (FIM) was used to assess physical and cognitive function. Delta-FIM was calculated by subtracting admission FIM from discharge FIM. One-year mortality, hospitalizations and fractures were assessed. RESULTS: Six-hundred-thirty elderly patients, post-hip fracture were included, mean age 83 ± 7 years, 70.5% (444) women. Among them, 193 (30.6%) had type 2 DM, HbA1c 6.6 ± 1.25%. They were younger (81.4 vs. 84.3 years, p < .01) and had more co-morbidities including hypertension, chronic kidney disease, ischaemic heart disease and cerebrovascular disease. Baseline cognitive and motor scores were similar between groups. Delta motor-FIM was similar between diabetics and non-diabetics (15.56 ± 8.95 and 14.78 ± 8.79, respectively, p = .35). Multivariate regression analysis showed motor-FIM improvement was associated with higher BMI, male sex, and younger age, but not with DM. Cognitive FIM did not change significantly during rehabilitation in either group. Similar rates of patients were discharged to nursing care facilities. There was no difference in 1-year hospitalization or fracture rates. One-year, all-cause mortality was higher among diabetic patients (10.9 vs. 6.6%, respectively, p = .07). After adjusting for covariates, DM was associated with higher mortality risk (odds ratio = 2.78, 95% CI [1.28, 6.04], p = .01). CONCLUSIONS: Patients with well-controlled DM have similar post-hip fracture rehabilitation potential compared with non-diabetics, despite more co-morbidities. These results support resource allocation for post-hip fracture rehabilitation among patients with DM. The higher 1-year all-cause mortality in patients with DM reinforces the need for close follow-up and control of co-morbidities in this population.

Pregnancy outcome of patients following deep venous thrombosis.

OBJECTIVE: To investigate pregnancy outcome of patients with a history of deep vein thrombosis (DVT). METHODS: A population-based study comparing all pregnancies of patients with and without a history of DVT was conducted. Deliveries occurred during the years 1988-2007 at a tertiary Medical Center. Stratified analyses were performed using multivariable logistic regression models and the Mantel-Haenszel technique. RESULTS: During the study there were 212,086 deliveries, of which 122 (0.06%) occurred in patients with a history of DVT. Using a multivariate analysis, with backward elimination, the following conditions were significantly associated with DVT: advanced maternal age (OR, 1.1; 95% CI, 1.02-1.1; p = 0.004), chronic hypertension (OR, 2.9; 95% CI, 1.4-6.0; p = 0.005) and previous caesarean delivery (OR, 2.8; 95% CI, 1.9-4.1; p < 0.001). Patients with a history of DVT were more likely to have caesarean deliveries (OR, 2.6; 95% CI, 1.8-3.8; p < 0.001) than non-DVT patients. After controlling for possible confounders, such as maternal age, hypertensive disorders, pregestational diabetes and multiple gestations, by using another multivariate analysis with preterm delivery (<37 weeks' gestation) as the outcome variable, DVT was found to be an independent risk factor for preterm birth (OR, 1.8; 95% CI, 1.1-2.9; p = 0.033). This association remained significant after controlling for labor induction, using the Mantel-Haenszel technique (OR, 1.8; 95% CI, 1.1-3.0; p = 0.011). No significant differences were noted between the groups regarding perinatal outcomes such as low Apgar scores, congenital malformations or perinatal mortality. CONCLUSIONS: A history of DVT is an independent risk factor for spontaneous preterm delivery. Nevertheless, in our population it is not associated with adverse perinatal outcome.