OBJECTIVES: To identify determinants of mortality and institutionalization
after hip fracture and to identify those older hip fracture patients at hig
h risk of death or institutionalization after hip fracture.
DESIGN: Population-based prospective inception cohort study of hip fracture
patients; patients were assessed in the hospital and at 3 months following
the hip fracture.
SETTING: Edmonton area hip fracture patients admitted to one of two Edmonto
n, Alberta, Canada, acute care centers between July 10, 1996, and August 31
, 1997.
PARTICIPANTS: Patients were residents of the Edmonton area and over the age
of 64. Those who had previously fractured the same hip within the past 5 y
ears or had some pathological condition underlying the hip fracture were ex
cluded. Of 610 eligible patients, 558 contributed some baseline information
and were included in the mortality analysis; the institutionalization anal
ysis was restricted to the 338 patients who lived in the community before f
racture, survived the 3-month period postfracture, and had completed a 3-mo
nth follow-up interview.
MEASUREMENTS: The baseline interview was done in the hospital to assess men
tal status, prefracture physical function, prefracture health perception, a
nd prefracture social support. The 3-month follow-up interview was done by
phone to assess physical function, health perception, and social support 3
months postfracture. Demographic and comorbidity information was collected
from medical records.
RESULTS: Low mental status in hospital was found to increase the chances of
mortality and institutionalization, and male gender was found to increase
mortality risk fourfold. Each additional 10 years of age increased the risk
of institutionalization approximately 2.5 times. Patients with lower postf
racture physical function had at least five times the risk of institutional
ization compared to patients with high postfracture physical function.
xCONCLUSIONS: Cognitive impairment, older age, and gender were associated w
ith increased risk of poor outcome following hip fracture. The socioeconomi
c variables - social support and health perception - did not contribute sig
nificant additional information in explaining mortality or institutionaliza
tion risk. While demographic factors cannot be modified, physical function
3 months postfracture may be amenable to intervention and may reduce the ri
sk of institutionalization. Intervening to increase postfracture physical f
unction may be particularly beneficial to older patients, or to those who a
re cognitively impaired.