MOBILITY IN OLDER PATIENTS WITH HIP-FRACTURES - EXAMINING PREFRACTURESTATUS, COMPLICATIONS, AND OUTCOMES AT DISCHARGE FROM THE ACUTE-CARE HOSPITAL

The purpose of this study was to examine the relationships among prefr acture status, development of complications, mobility outcomes at disc harge, and disposition at discharge. We singled out a case series of c onsecutive noninstitutionalized elderly persons hospitalized for hip f racture (ICD 820.0-820.9) at two Baltimore hospitals during 1992-1993. Data were abstracted from the medical records for the following varia bles: sociodemographic information, prefracture status, selected medic al conditions, injury and surgical treatment, complications, functiona l mobility and assistance needed at discharge, and disposition. Factor s associated with four complications were identified from multiple log istic regression analyses. (a) Prefracture needs for assistance with a ctivities of daily living (ADL), and age greater than or equal to 80, were associated with the development of pressure ulcers. (b) Male gend er and prefracture urinary incontinence (UI) were associated with pneu monia. (c) Prefracture UI and weight-bearing status were associated wi th UI after removal of an indwelling catheter. (d) Age greater than or equal to 80 was associated with urinary retention. The amount of assi stance needed for mobility tasks at discharge was associated with pref racture need for assistance with ADLs, gender, weight-bearing status, and hospitals with shorter lengths of stay and fewer physical therapy sessions. Patients who were older and had shorter lengths of stay and less physical therapy were more likely to go to another health facilit y than directly home. Prefracture status (ADL, prefracture UI) was sig nificantly associated with the development of complications. Prefractu re needs for assistance with ADL and complications were associated wit h mobility outcomes at discharge. These prefracture factors have an ef fect on outcomes and need to be addressed in the development of critic al pathways for case treatment. Specific protocols for subgroups of pa tients may need to be designed and evaluated.