[FUNCTIONAL INDEPENDENCE MEASURE SCALE SCORES IN SEVERELY DEPENDENT OLDER ADULTS UPON REHABILITATION COMPLETION FOLLOWING HIP FRACTURE].

INTRODUCTION: Functional Independence Measure (FIM) is a scale used to evaluate functional status during rehabilitation. The association between FIM scale scores upon hip fracture rehabilitation completion and functional status of older adults according to the Israeli Ministry of Health (MOH) guidelines has never been studied. AIMS: To study the association between FIM scale scores upon hip fracture rehabilitation completion and functional status of older adults. METHODS: A retrospective cross-sectional study was conducted at the Geriatric-Orthopedic unit at the Sheba Medical Center. The medical charts of older adults (age ≥65) admitted for rehabilitation following hip fracture during 2007-2012 were studied. Age, gender, total FIM score upon rehabilitation completion, functional status upon rehabilitation completion according to the Israeli MOH guidelines, and moving to a nursing-home were documented. RESULTS: The cohort included 453 older adults: 374 (82.6%) females; mean age 82.9±6.7 years. Most older adults were severely dependent upon rehabilitation completion (n=320, 70.6%) and 84 (26.3%) of whom moved to or returned to a nursing-home. Median total FIM scores upon rehabilitation completion was 100 (interquartile range (IQR): 92-111) in mildly dependent older adults, 72 (IQR: 53-87) in severely dependent community-dwelling older adults, and 39 (IQR: 29-58) in severely dependent nursing-home residents (p<0.001). Total FIM score of 85 (or less) had the highest sensitivity (78.4%) and specificity (91.0%) in representing severely dependent older adults. CONCLUSIONS: These findings may assist Israeli geriatricians to define the functional status of older adults upon hip fracture rehabilitation completion.

Prerehabilitation alanine aminotransferase blood levels and one-year mortality rates in older adults following hip fracture.

Low alanine aminotransferase (ALT) blood levels prior to rehabilitation are associated with poor function in older adults following hip fracture. We hypothesized that low ALT blood levels prior to rehabilitation were also associated with one-year mortality in this population. Included were 456 older adults (age ≥ 60 years, 82.5% women) admitted for rehabilitation following hip fracture. ALT blood levels were documented between one and six months prior to rehabilitation. Excluded were patients with ALT blood levels over 40 IU/L possibly consistent with liver injury. The main outcome was all-cause mortality one year following rehabilitation admission. The study group included 142 (31.1%) patients with low (≤10 IU/L) ALT blood levels and the control group included 314 (68.9%) patients with high-normal (11-40 IU/L) ALT blood levels. Overall, 52 (11.4%) patients died within one year following rehabilitation admission. Compared with the control group, patients with low ALT blood levels had significantly higher 1-year mortality rates [17.6 vs. 8.6%, odds ratio 2.27, 95% confidence interval (CI) 1.27-4.08]. Cox regression analysis showed that low ALT blood levels prior to rehabilitation were associated with one-year mortality (hazard ratio 1.88, 95% CI 1.08-3.28) together with age (hazard ratio 1.06, 95% CI 1.02-1.11), independent of gender. However, this association was no longer significant following adjustment also for peripheral vascular disease, admission and discharge functional independence measure scores, albumin serum levels, and length of rehabilitation. In conclusion, low ALT blood levels prior to rehabilitation are associated with one-year mortality in older adults following hip fracture. They may be used when only age and gender are known.