A LONGITUDINAL EXAMINATION OF FUNCTIONAL RECOVERY AMONG OLDER-PEOPLE WITH SUBCAPITAL HIP-FRACTURES

OBJECTIVE: Few studies have examined the time-dependent change in func tional recovery along with the factors that affect the change among ol der hip fracture patients. The focus of this study is to examine the p redictors of functional recovery in community-dwelling older people wi th subcapital fractures using longitudinal data analysis methods. DESI GN: A 1-year prospective study. Information was obtained through struc tured interviews following surgery and at 2, 6, and 12 months after ho spital discharge and from medical chart review. SETTING AND PATIENTS: The sample consisted of 312 community-dwelling older adults, admitted to one of the seven Baltimore area hospitals with a subcapital fractur e, who received either internal fixation or hemiarthroplasty. RESULTS: The longitudinal data analysis using mixed-effects regression indicat es that time and prefracture physical activities of daily living (PADL ) had a significant association with PADL functional recovery over the course of 1 year. Among those 85 years and older, those who were diso riented after surgery had poorer PADL functional recovery over time th an those who were not disoriented. Also, recovery in instrumental acti vities of daily living (IADL) was associated significantly with time, prefracture IADL function, unsteady gait prefracture, hospital length of stay, and discharge to an institution. The type of surgical procedu re performed was not associated significantly with either PADL or IADL functional recovery. CONCLUSIONS: The factors that are related to fun ctional recovery in this study shed light on the complexity of the rec overy process in hip fracture patients. The rate of recovery in postsu rgical PADL and IADL function is not constant over time; postsurgical IADL function among disoriented patients (without dementia) continues to deteriorate over time compared with the nondisoriented group; this difference in trends of deterioration on IADL function is most profoun d in the oldest-old aged group, those 85 and older. The types of surgi cal procedure performed was not significantly associated with postsurg ical functional recovery.