Recovery of Function Following a Hip Fracture in Geriatric Ambulatory Persons Living in Nursing Homes: Prospective Cohort Study

Objectives To measure 1-year post-hip fracture functional recovery, health-related quality of life (HRQL), and mortality in nursing home residents. Design Prospective longitudinal cohort study. Setting and Participants Ambulatory nursing home residents with or without impaired cognition consecutively admitted with hip fracture to three Canadian tertiary-care hospitals from March 2008 through November 2009. Measurements Participants or proxy respondents completed the Functional Independence Measure Motor score (FIMmotor) and EuroQol5D index score (EQ-5Dindex) in the hospital (prefracture status) and 3, 6, and 12 months after fracture. Complications over the first postfracture year were also ascertained; the primary outcome was functional recovery (change in FIMmotor score). Results Of 92 eligible participants, 60 (64%) were enrolled. The mean age was 86.9 +/- 8.1, 42 (70%) were female, and 45 (75%) had three or more comorbidities. Forty-three (72%) walked independently with or without aids before fracture. By 12 months, 27 (45%) participants had died, and 10 (17%) had withdrawn. Of the remaining 23 participants, functional status according to FIMmotor score dropped substantially and significantly after the fracture (3 months, 34.0 +/- 19.7; 6 months, 33.2 +/- 19.7; 12 months, 32.0 +/- 20.0; P < .001 from a baseline FIMmotor score of 50.1 +/- 16.1). By 12 months after the fracture, only eight (35%) were walking independently, and 11 (48%) were no longer ambulatory. HRQL according to the EQ-5Dindex also decreased significantly (P = .003), from 0.62 +/- 0.20 before fracture to 0.42 +/- 0.30 by 12 months after fracture. Conclusion Hip fracture for nursing home residents was associated with substantial loss of functional independence, ambulation, and HRQL. Little recovery was evident after the first 3 months; there was almost 50% mortality within 12 months.