Functional dependency and COVID-19 in elderly patients with mild to moderate disease. Experience of tertiary geriatric hospital.

Clinical course of COVID-19 may be associated with functional dependency of geriatric patients. Data from the records of patients admitted to the COVID-19 Geriatric Unit were gathered during three months, including background, clinical aspects, time to resolution of infection and functional status. Functionally dependent patients had higher rates of diabetes (p = 0.03) and stroke (p = 0.004), as well as longer time to resolution of infection (p < 0.001), but less respiratory COVID-19 symptoms (p = 0.007), compared to independent patients. Time to resolution of infection was longer in women (p = 0.01) and positively associated with WBC level (p < 0.01) and age (p < 0.001). An adjusted analysis which controlled these variables confirmed the significant effect of functional status on the time to resolution of infection (p = 0.015). Functionally dependent geriatric patients with mild to moderate infection had less respiratory COVID-19 symptoms but showed longer time to resolution of infection compared to independent. Assessment of functional status in the elderly population may contribute to decision making for care of geriatric inpatients with COVID-19.

Time to Resolution of Infection in COVID-19 Patients: the Experience of a Tertiary Medical Center in Israel.

With the spread of coronavirus disease, reports have indicated that young patients are usually asymptomatic with a short convalescence period. The current study compared the time to resolution of infection in symptomatic and asymptomatic patients. Seventy-six patients aged 44.4 ± 23.3 years were admitted to the coronavirus disease 2019 (COVID-19) unit during the study period. Data were collected from patient records. Throat and nasal swabs for COVID-19 were collected for reverse transcriptase-polymerase chain reaction (RT-PCR). Time to resolution of infection was defined as the number of days from the date of the first COVID-19 positive outcome to the second consecutive negative PCR results. Most patients showed COVID-19 signs and symptoms (71.1%) between 1 and 6 days, and the rest were asymptomatic. No association was found between the time to resolution of infection and the presence of COVID-19 signs and symptoms (symptomatic: median [Md] 10.0, 95% confidence interval [CI] 8.4-11.6; asymptomatic: Md 15.0, 95% CI 10.5-15.5; P = 0.54). Age was not correlated with the number of COVID-19 signs and symptoms (r = 0.13, P = 0.37) or with the time to resolution of infection (r = 0.06, P = 0.58). In patients with mild to moderate symptoms, the time to resolution of infection from COVID-19 is not different from that in asymptomatic patients.

Is There an Association between Norton Scale and Cognitive Impairment in Hip Fractured Elderly Patients?

INTRODUCTION: Geriatric assessment as an integrative part of assessment is a composite of a large number of scales. Sometimes it is difficult to transfer all of them. The Norton Scale Score (NSS) assesses the degree of risk to develop bedsores. In previous studies, a correlation between Norton Scale and function was found. A correlation between Norton Scale and cognitive assessments was not evaluated yet. The aim of this study was to determine if there is an association between Norton Scale Score and cognitive impairment. This association can further facilitate geriatric assessment in frail older patients, especially in older patients with communicative difficulties. METHODS: We have performed an observational cohort study which included hip fractured older patients consecutively admitted to the rehabilitation ward of the Shmuel Harofe Geriatric Medical Center. The collected data included demographic data and data on chronic illnesses. Results of cognitive status assessment (Mini-Mental State Examination - MMSE) and Norton Scale assessment were received from the computerized patients' charts. We evaluated the association between these 2 scales. RESULTS: The study included 224 consecutive hip fracture patients with a mean age of 81.78 ± 7.19 years. Norton scores at admission, age, education, and previous stroke emerged as the only statistically significant parameters differing between those with cognitive decline and those without it. After adjusting for confounding variables, lower Norton scores at admission (OR 1.303, CI: 1.097-1.548, p = 0.003) were associated with an increased risk finding for cognitive impairment. CONCLUSION: Our findings suggest that there is an association between Norton Scale Scores and cognitive impairment. Norton score parameters, under certain circumstances, such as speech and other communication difficulties, can be used as a proxy measure for MMSE to indicate cognitive impairment. These findings can be even more helpful in the present time of "COVID-19," when we have to evaluate older patients with facial masks and other defensive suits.

The association between Norton scale gain and functional outcome among older hip fracture patients.

AIM: This study examines interrelations between gains of Norton Scale Score (NSS) and functional outcome measured by Functional Independence Measurement (FIM) among older hip fracture patients. DESIGN: Retrospective study. METHODS: We examined 227 patients consecutively hospitalized in a geriatric postacute rehabilitation ward. The data were collected during 2012-2017. Data were analysed using Student's t test, chi-square test, Pearson's correlation coefficient and linear regression. RESULTS: Patients with positive NSS gains demonstrated statistically significant higher total FIM, motor FIM and total FIM gain scores at hospital discharge, compared with patients showing no NSS gains or negative NSS. Multiple regression analysis indicated that positive NSS gains were independently predictive for higher total FIM and motor FIM scores at hospital discharge and higher motor FIM gains at discharge. CONCLUSION: Our results suggest that positive NSS gains are associated with higher FIM scores at hospital discharge and may assist in predicting the functional outcome of hospitalized older hip fracture patients.

An Information Theory Approach for the Analysis of Individual and Combined Evaluation Parameters of Multiple Age-Related Diseases.

In view of the frequent presence of several aging-related diseases in geriatric patients, there is a need to develop analytical methodologies that would be able to perform diagnostic evaluation of several diseases at once by individual or combined evaluation parameters and select the most informative parameters or parameter combinations. So far there have been no established formal methods to enable such capabilities. We develop a new formal method for the evaluation of multiple age-related diseases by calculating the informative values (normalized mutual information) of particular parameters or parameter combinations on particular diseases, and then combine the ranks of informative values to provide an overall estimation (or correlation) on several diseases at once. Using this methodology, we evaluate a geriatric cohort, with several common age-related diseases, including cognitive and physical impairments (dementia, chronic obstructive pulmonary disease-COPD and ischemic heart disease), utilizing a set of evaluation parameters (such as demographic data and blood biomarkers) routinely available in geriatric clinical practice. This method permitted us to establish the most informative parameters and parameter combinations for several diseases at once. Combinations of evaluation parameters were shown to be more informative than individual parameters. This method, with additional clinical data, may help establish the most informative parameters and parameter combinations for the diagnostic evaluation of multiple age-related diseases and enhance specific assessment for older multi-morbid patients and treatments against old-age multimorbidity.

Functional Outcome of Elderly Hip Fracture Patients Is Not Affected By Prefracture Dementia.

OBJECTIVE: The aim of the study was to examine whether a diagnosis of prefracture dementia (PFD) affects functional outcome at discharge from a geriatric rehabilitation setting. DESIGN: A total of 211 consecutive elderly hip fracture patients were evaluated retrospectively. We used the Functional Independence Measure (FIM) and analyzed data by t test, χ(2) test, and multiple linear regression analysis. RESULTS: Patients with PFD were older (P = 0.001), presented with lower Mini-Mental State Examination scores (P < 0.001) and lower prefracture function (P < 0.001). Total-FIM and motor-FIM scores at admission and discharge, as well as FIM gain scores at discharge, were lower among patients with PFD, compared with nonprefracture dementia (NPFD) patients (P < 0.001). The FIM daily gains (efficiency) (P < 0.001) and Montebello relative functional scores (P < 0.001) were also lower in PFD, compared with patients with NPFD. However, linear regression analysis showed that PFD did not predict total, motor, or FIM gain at discharge (ß = -0.11, P = 0.115; ß = -0.06, P = 0.412; ß = -0.099, P = 0.329, respectively). Upon discharge, patients with PFD achieved lower FIM scores yet maintained similar motor-FIM gains compared with patients with NPFD. CONCLUSIONS: Our study results supports the inclusion of patients with PFD in postfracture rehabilitation programs.

The application of information theory for the estimation of old-age multimorbidity.

Elderly patients are commonly characterized by the presence of several chronic aging-related diseases at once, or old-age "multimorbidity," with critical implications for diagnosis and therapy. However, at the present there is no agreed or formal method to diagnose or even define "multimorbidity." There is also no formal quantitative method to evaluate the effects of individual or combined diagnostic parameters and therapeutic interventions on multimorbidity. The present work outlines a methodology to provide such a measurement and definition, using information theoretical measure of normalized mutual information. A cohort of geriatric patients, suffering from several age-related diseases (multimorbidity), including ischemic heart disease, COPD, and dementia, were evaluated by a variety of diagnostic parameters, including static as well as dynamic biochemical, functional-behavioral, immunological, and hematological parameters. Multimorbidity was formally coded and measured as a composite of several chronic age-related diseases. The normalized mutual information allowed establishing the exact informative value of particular parameters and their combinations about the multimorbidity value. With the currently intensifying attempts to reduce aging-related multimorbidity by therapeutic interventions into its underlying aging processes, the proposed method may outline a valuable direction toward the formal indication and evidence-based evaluation of effectiveness of such interventions.

Action Observation of Motor Skills Followed by Immediate Sleep Enhances the Motor Rehabilitation of Older Adults With Stroke.

BACKGROUND AND PURPOSE: Motor rehabilitation following stroke is a demanding challenge in search for new strategies to improve outcome. Rehabilitation through action observation has been reported beneficial for older adults recovering from stroke. Early sleep session following motor learning enhanced the performance of the acquired motor skills. The purpose of this study was to examine whether an early sleep session following action observation has benefit over action observation alone in the rehabilitation of older adults after stroke. METHODS: Twenty patients with paresis of dominant upper limb in first ischemic stroke were assigned to 2 study groups (10 subjects each). The participants were presented a 5-minute video film of phone operation. Participants of the intervention group had a sleep session of 90 to 120 minutes immediately following the film while control participants did not sleep. Identical procedure was repeated for 4 consecutive sessions (4 weeks). A single item of the Chedoke Arm and Hand Activity Inventory was used as rehabilitation's outcome measure. RESULTS: During the 4 weeks of the study, the performances of both groups improved but the intervention group had higher Chedoke Arm and Hand Activity Inventory scores, as indicated by a significant session by group interaction (P < .001). CONCLUSIONS: An early sleep session added to action observation therapy may significantly improve motor performances of patients with stroke. Further studies are required to support this method for inclusion in rehabilitation arsenal.

Impact of the Holocaust on the Rehabilitation Outcome of Older Patients Sustaining a Hip Fracture.

BACKGROUND: Holocaust survivors report a much higher prevalence of osteoporosis and fracture in the hip joint compared to those who were not Holocaust survivors. OBJECTIVES: To evaluate whether being a Holocaust survivor could affect the functional outcome of hip fracture in patients 64 years of age and older undergoing rehabilitation. METHODS: A retrospective cohort study compromising 140 consecutive hip fracture patients was conducted in a geriatric and rehabilitation department of a university-affiliated hospital. Being a Holocaust survivor was based on registry data. Functional outcome was assessed by the Functional Independence Measure (FIM)TM at admission and discharge from the rehabilitation ward. Data were analyzed by t-test, chi-square test, and linear regression analysis. RESULTS: Total and motor FIM scores at admission (P = 0.004 and P = 0.006, respectively) and total and motor FIM gain scores at discharge (P = 0.008 and P = 0.004 respectively) were significantly higher in non-Holocaust survivors compared with Holocaust survivors. A linear regression analysis showed that being a Holocaust survivor was predictive of lower total FIM scores at discharge (ß = -0.17, P = 0.004). CONCLUSIONS: Hip fracture in Holocaust survivors showed lower total, motor FIM and gain scores at discharge compared to non-Holocaust survivor patients. These results suggest that being a Holocaust survivor could adversely affect the rehabilitation outcome following fracture of the hip and internal fixation.

Low Borderline Levels of Serum Vitamin B12 May Predict Cognitive Decline in Elderly Hip Fracture Patients.

BACKGROUND: The progression from cognitive impairment to dementia is a multifactorial process that involves genetic and environmental factors. Vitamin B12 deficiency can be an important factor in the progress from cognitive decline to dementia. OBJECTIVES: To examine the relationship between borderline low level of vitamin B12 (≤ 350 pg/ml) and cognitive decline among a group of elderly hip fracture patients. METHODS: This retrospective chart review study was conducted in a geriatric rehabilitation ward of a university-affiliated referral hospital. It comprised 91 elderly hip fracture patients. Cognition was assessed by the Mini-Mental State Examination (MMSE) tool. Fasting serum vitamin B12 levels were measured within 24 hours after admission to the rehabilitation ward. RESULTS: Twenty-two of the patients had vitamin B12 levels ≤ 350 pg/ml. In a multiple linear regression analysis, after adjusting for confounding variables, serum vitamin B12 levels ≤ 350 pg/ml were linked to a higher risk of developing cognitive decline (ß coefficient = -0.28, P = 0.008). CONCLUSIONS: In our study, serum vitamin B12 levels ≤ 350 pg/ml, were independently associated with lower MMSE scores in elderly hip fracture patients. Serum vitamin B12 may assist in identifying patients in the early stages of cognitive decline. This study joins others that have reported on the association of low normal range vitamin B12 blood levels and conditions like dementia, falls, fractures and frailty. We suggest a reexamination of what is currently considered as the normal range of vitamin B12 in the elderly.

Pre-stroke dementia does not affect the post-acute care functional outcome of old patients with ischemic stroke.

AIM: The purpose of the present study was to evaluate whether a diagnosis of dementia before stroke onset (pre-stroke dementia [PSD]) affects the short-term functional outcome of elderly ischemic stroke patients. METHODS: This was a retrospective case-control study comprising of consecutive elderly ischemic stroke patients. Functional outcome was assessed by the Functional Independence Measure scale (FIM) at admission and discharge. Data was analyzed by t-test, χ(2) -test, multiple linear regression analysis and logistic regression. RESULTS: There were 919 patients with acute ischemic stroke, out of whom 11.5% were diagnosed with PSD on index day. Compared with non-PSD patients, those with pre-stroke dementia had a shorter length of stay (P < 0.001), higher rate of female patients (P < 0.001) and lower Mini-Mental State Examination scores (P < 0.001). Both total and motor FIM scores at admission and discharge, and their respective FIM gain scores at discharge were higher in non-PSD compared with PSD patients (P < 0.001). In logistic regression analysis to identify factors predicting successful outcome (defined as total FIM at discharge ≥80), PSD remained as significantly associated with increased risk for adverse outcome on discharge (OR 2.449, CI 1.207-4.970, P = 0.013). CONCLUSIONS: The present findings suggest that a diagnosis of pre-stroke dementia is associated with lower FIM scores at admission and discharge in patients with ischemic stroke. Yet, daily motor FIM gains were similar in PSD and non-PSD patients, suggesting that these patients should not be deprived of a post-acute rehabilitation, based on a diagnosis of dementia before stroke onset. Geriatr Gerontol Int 2016; 16: 928-933.

Gender differences in functional outcome of elderly hip fracture patients.

AIM: The purpose of the present study was to investigate whether gender might affect functional outcome of hip fractured patients undergoing in-hospital rehabilitation. METHODS: This was a retrospective chart review study comprising of 759 consecutive elderly patients suffering traumatic hip fracture. All patients underwent a standard orthogeriatric care of surgical hip repair and post-acute rehabilitation care. Functional outcome (female vs male gender) was assessed by motor and total Functional Independence Measurement (FIM) scores on discharge. Data was analyzed by t-tests χ(2) -test and multiple linear regression analyses. RESULTS: A total of 574 (75.6%) out of all patients were females. There were no differences in admission FIM scores; however, male patients had a higher prevalence of comorbidities. FIM scores on discharge were higher in female patients (motor FIM, P=0.007; motor FIM gain, P=0.001; compared with males). A multiple linear regression analysis showed that female gender was independently associated with higher total FIM at discharge (ß coefficient=0.056, P=0.008), higher motor FIM at discharge (ß coefficient=0.071, P=0.007) and higher total FIM gain at discharge (ß coefficient=0.11, P=0.008). CONCLUSION: The findings suggest that absolute discharge FIM scores of females are higher, compared with male patients. After adjusting for possible covariates, female gender still emerged as an independent predictor for higher FIM at discharge, suggesting that male gender should be considered as adversely affecting rehabilitation outcome of hip fracture male patients.

Eating management and functional outcome of elderly patients with symptomatic ischemic stroke undergoing inpatient rehabilitation.

AIM: The purpose of this study was to investigate whether, and to what extent, post-stroke eating management (EM) at admission to a rehabilitation ward is associated with functional outcome. METHODS: This was a retrospective study comprising 716 consecutive elderly patients with first ever symptomatic ischemic stroke. Level of eating management was determined by Functional Independence Measurement (FIM) subscale scores relevant to eating management, where scores ≤ 5 points define low-eating management (Low-EM) ability and scores >5 indicate independent eating management. Data was analyzed by t-test, χ(2) -test, Pearson's correlation and by multiple linear regression analysis. RESULTS: A total of 418 and 298 Low-EM and High-EM patients, respectively, were eligible for final analysis. Compared with High-EM, Low-EM patients were slightly older (P=0.04), had longer rehabilitation stays (P<0.001) and lower Mini-Mental State Examination (MMSE) scores (P<0.001). Total FIM at admission and discharge were lower in Low-EMS, yet there was no statistically significant difference in total FIM gain on discharge between the two groups. Multiple linear regression analyses showed that total FIM at discharge was inversely associated with Low-EM at admission (ß-coefficient= -0.389, P<0.001). Low-EM scores were independently predictive for higher total FIM gain at discharge (ß-coefficient=0.125, P=0.005). CONCLUSION: The findings suggest that impaired eating management on admission is associated with adverse functional outcome. However, patients presenting to rehabilitation with impaired eating management do obtain significant functional gains and should not be deprived of rehabilitation.

Increased 1-year mortality rates among elderly hip fracture patients with atrial fibrillation.

BACKGROUND AND AIMS: Prediction of factors associated with survival following hip fracture is important. We studied crude and adjusted survival rates in elderly hip fracture patients with and without atrial fibrillation (AF) to assess possible risk of death associated with AF. METHODS: A historical prospective cohort study, comprising 1114 consecutive patients with hip fractures. Subjects were divided into three groups: patients with sinus rhythm (SR), paroxysmal atrial fibrillation (PAF) or chronic atrial fibrillation (CAF). The main outcome measures were crude and adjusted survival rates at 30, 90 and 365 days, and end of follow-up. RESULTS: AF patients differed from SR patients by gender (p=0.0018), age (p=0.008), heart failure (p<0.001), ischemic heart disease (p<0.001) and history of a stroke (p<0.001). The lowest death rates were observed among SR and PAF patients, whereas CAF patients had the highest rates at each follow-up time point. CAF (but not PAF or SR) patients were at a significantly higher risk of death at both 365 days and at the end of the study (HR 1.786, CI 1.011- 3.155 and HR 1.835, CI 1.302-2.585, respectively). Older age (HR 1.301, CI 1.135-1.491 and HR 1.321, CI 1.321-1.415) and male gender (HR 1.879, CI 1.271- 2.779 and HR 1.545, CI 1.251-1.909) also predicted higher risk of death at both 365 days and at the end of the study. CONCLUSIONS: Atrial fibrillation cannot be considered to adversely affect short-term survival of hip fracture patients. After 365 day, CAF was associated with a significantly higher risk of death.

Atrial fibrillation is not associated with rehabilitation outcomes of elderly hip fracture patients.

AIM: To study possible differences in rehabilitation outcomes of patients with hip fracture, with and without atrial fibrillation. METHODS: A retrospective cohort study comprising 1114 patients, divided into three groups: patients with sinus rhythm, paroxysmal atrial fibrillation or chronic atrial fibrillation. All patients underwent a standard orthogeriatric care comprising surgical hip repair and a rehabilitation course. Main outcome measures included functional status at discharge by the Functional Independence Measure, post-fracture functional status category and type of postdischarge living arrangement. RESULTS: Patients with atrial fibrillation differed from patients in sinus rhythm by female sex (P = 0.018), older age (P = 0.008) and higher rates of heart failure (P < 0.001), ischemic heart disease (P < 0.001), previous stroke (P < 0.001), and American Society of Anesthesiologists score (P < 0.001). No differences were observed among the three groups regarding Functional Independence Measure motor and total scores. In regression analysis, Mini-Mental State Examination (P < 0.001), prefracture status (P < 0.001), postsurgery motor Functional Independence Measure (P < 0.0001) and Parkinson's disease (P = 0.009) were predictive of higher motor Functional Independence Measure at discharge, whereas atrial fibrillation had no predictive value whatsoever. There were no differences among groups in magnitude of postfracture change of functional status category or type of postdischarge living arrangement. CONCLUSIONS: Discharge motor Functional Independence Measure scores, postfracture changes in functional status and in discharge placement are similar in hip fracture patients with sinus rhythm, compared with those with atrial fibrillation. Atrial fibrillation should not be considered to adversely affect the rehabilitation outcome of these patients.

Prevalence and correlates of psychotropic medication use among older adults in Israel: cross-sectional and longitudinal findings from two cohorts a decade apart.

OBJECTIVES: To assess: (1) changes in use of psychotropic medications across two cohorts, 10 years apart, of community-dwelling elderly and the socio-demographic, physical and mental health correlates of their use; and (2) changes in psychotropic medication use over 3.5 years follow-up. METHODS: Data were taken from two national surveys of the Israeli Jewish population aged 75­94, which, respectively, sampled two cohorts in 1989 (n=1200) and again in 1999 (n=421). Psychotropic medications were assessed from the list of all medications recorded during a face-to-face interview. The current analysis focused on two medication groups: anxiolytics and sedatives/hypnotics and antidepressants. RESULTS: Sedatives/hypnotics and anxiolytics use increased from 22.2% in 1989 to 25.4% in 1999 and antidepressants from 3.8% to 4.8% (both nonsignificantly) corresponding to a decline in the health profile of community-dwelling older adults. Similar patterns of associations were observed for socio-demographics, physical, and mental health status indicators with the use of psychotropic medications across the two cohorts. The pooled multivariate analysis showed significantly higher use of sedative/hypnotics and anxiolytics among women and lower use among religious elderly. Additional risk factors were sleeping problems, number of other medications, depressive symptoms, and traumatic life events. Antidepressants use was related to a higher education, ADL disability, and depressive symptoms. Longitudinally, use of psychotropic medications was not significantly different among participants who were followed again after 3.5 years. CONCLUSIONS: Sedative/hypnotics and anxiolytics use was relatively high while antidepressants use was low even among depressed elderly suggesting that some depressed elderly were treated inappropriately with benzodiazepines.

Functional outcome of elderly survivors of ischemic stroke: a retrospective study comparing nonhypercholesterolemic and hypercholesterolemic patients.

BACKGROUND: Total cholesterol is significantly associated with increased risk of ischemic stroke. Patients with ischemic stroke and high cholesterol levels may show better functional outcome after rehabilitation. OBJECTIVES: To study the possible interrelations between hypercholesterolemia and functional outcome in elderly survivors of ischemic stroke. METHODS: We conducted a retrospective chart review study of consecutive patients (age > or = 60 years) with acute stroke admitted to a geriatric rehabilitation ward in a university-affiliated hospital. The presence or absence of hypercholesterolemia was based on registry data positive for hypercholesterolemia, defined as total cholesterol > or = 200 mg/dl (5.17 mmol/L). Functional outcome of patients with hypercholesterolemia (Hchol) and without (NHchol) was assessed by the Functional Independence Measurement scale (FIM) at admission and discharge. Data were analyzed by t-test and chi-square test, as well as linear regression analysis. RESULTS: The complete data for 551 patients (age range 60-96 years) were available for final analysis; 26.7% were diagnosed as having hypercholesterolemia. Admission total FIM scores were significantly higher in patients with Hchol (72.1 +/- 24.8) compared with NHchol patients (62.2 +/- 24.7) (P < 0.001). A similar difference was found at discharge (Hchol 90.8 +/- 27.9 vs. NHchol 79.7 +/- 29.2, P < 0.001). However, total FIM change upon discharge was similar in both groups (18.7 +/- 13.7 vs. 17.6 +/- 13.7, P = 0.4). Regression analyses showed that high Mini Mental State Examination scores (beta = 0.13, P = 0.01) and younger age (beta = -0.12, P = 0.02) were associated with higher total FIM change scores upon discharge. Total cholesterol was not associated with better total FIM change on discharge (beta = -0.012, P = 0.82). CONCLUSIONS: Elderly survivors of stroke with Hchol who were admitted for rehabilitation showed higher admission and discharge FIM scores but similar functional FIM gains as compared to NHchol patients. High cholesterol levels may be useful in identifying older individuals with a better rehabilitation potential.

Improved survival of hip fracture patients treated within a comprehensive geriatric hip fracture unit, compared with standard of care treatment.

OBJECTIVES: To compare survival rates of hip fracture patients treated within a comprehensive geriatric hip fracture unit (CGHFU) with those undergoing a standard of care treatment (SOCT) in general orthopedic wards. DESIGN: Retrospective chart review. SETTING: A geriatric hip fracture unit of a division of geriatric medicine and rehabilitation and departments of general orthopedic surgery of a tertiary hospital. PARTICIPANTS: Participants were 3114 consecutive hip fracture patients: 847 were admitted to CGHFU and 2267 to wards of general orthopedics. INTERVENTION: Surgical repair followed by standard rehabilitation course MEASUREMENT: Mortality rates at 30 days, 90 days, and 1 year. RESULTS: CGHFU population was older (P < .0001), comprised more women (P < .0001), and suffered a greater number of comorbidities (P < .0001). Crude 30-day mortality rates were 1.9% and 3.0% for CGHFU and SOCT, respectively. At 90 days, crude rates were 6.5% and 8.1%, respectively, and 14.8% and 17.3%, at 1 year, respectively. Cox proportional hazard models adjusted for sociodemographics, Comorbidity, and surgery characteristics showed borderline significant lower mortality hazard ratios for CGHFU in comparison with SOCT, for 1-month and 3-month intervals. The adjusted Cox model favored the CGHFU modality of care with regard to 1-year cumulative mortality (hazard ratios 0.78, 95% confidence interval 0.63-0.96, P = .016). Male gender, age, diabetes, and number of operations were predictive of increased 1-year mortality risk in the separate regression models by gender and age group (<85, 85+). CONCLUSION: Crude and adjusted mortality rates are lower in a geriatric hip fracture unit, as compared with the common standard of care model of general orthopedic wards. Combined with earlier data on improved functional outcomes of CGHFU, these findings further support the implementation of similar comprehensive orthogeriatric models of care.

Elevated blood urea, independent of glomerular filtration rate (GFR), confers increased risk of adverse functional outcome in elderly hip fracture patients.

This retrospective cohort study investigated the possible interrelations of GFR and functional outcome in elderly hip fracture patients. The final analyses comprised 499 consecutive patients undergoing standard medical, surgical and rehabilitation treatment in an orthogeriatric unit of a tertiary care hospital. Functional outcomes were assessed by Functional Independence Measurement (FIM™) scores. Kidney function was assessed by blood urea and creatinine, as well as by GFR according to the modification diet of renal disease study (MDRDS) formula. Mean age was 83.60 ± 5.14 and mean GFR 61.07 ± 17.22 ml/min. GFR was <60 ml/min in 91.8% out of all patients. FIM admission and discharge scores, and gains, were not associated with GFR values, except for discharge motor FIM which was significantly higher in patients with GFR greater than 30 ml/min (p = 0.043). In regression analysis, GFR was associated with motor FIM at discharge (ß = 0.028, p = 0.022). Neither GFR nor creatinine was associated with discharge total FIM. In contrast, lower admission urea levels were predictive of higher motor (correlation coefficient (CC) = 0.151, odds ratio (OR) 0.132, 95% confidence interval (CI) = 0.027-0.237, p = 0.013) and total FIM scores (CC = -0.022, OR = 0.978, 95%CI = 0.960-0.997, p = 0.022) at discharge. We suggest that GFR and creatinine are poorly associated with functional outcome. Instead, urea is more likely to predict functional outcome, and may serve as more reliable biomarker for the prognostication of functional outcome.