Survival and Functional Outcomes After Hip Fracture Among Nursing Home Residents
Survival and Functional Outcomes After Hip Fracture Among Nursing Home Residents
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DOI：
10.1001/jamainternmed.2014.2362
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发表时间：
2014-08-01
影响因子：
39
通讯作者：
Werner, Rachel M.
中科院分区：
文献类型：
--
作者：
Neuman, Mark D.;Silber, Jeffrey H.;Werner, Rachel M.
重要性鲜为人知的是，关于髋关节骨折后的长期nursing home residents.OBJECTIVE描述的模式和预测的死亡率和功能下降的活动，日常生活在nursing home residents after hip fracture.DESIGN，SETTING，AND PARTICIPANTS回顾性队列研究的60 111名医疗保险受益人居住在疗养院谁是住院与髋关节骨折之间的7月1日，2005年和2009年6月30日。主要结果和措施数据来源包括医疗保险索赔和疗养院最低数据集。主要结局包括骨折后180天内任何原因导致的死亡，以及180天内最近一次评估时死亡或新的运动完全依赖的复合结局。额外的分析描述了居民内的功能变化，在7个日常生活活动能力的前，后fracture. Results的60 111例，21 766（36.2%）骨折后180天死亡;在患者不完全依赖于运动在基线，53.5%的死亡或发展新的总依赖180天内。在个体患者中，骨折后评估的所有ADL领域的功能均大幅下降。在校正分析中，骨折后生存率下降最大的是年龄大于90岁的患者（与≥ 75岁：风险比[HR]，2.17; 95% CI，2.09-2.26 [P < .001]），非手术骨折治疗（与内固定相比：死亡HR为2.08; 95% CI为2.01-2.15 [P < .001]）和晚期合并症（Charlson评分>= 5 vs 0：HR为1.66; 95% CI为1.58-1.73 [P < .001]）。在180天内死亡或新的完全依赖运动的综合风险在非常严重的认知障碍患者中最大（与完整认知：相对危险度[RR]，1.66; 95%CI，1.56-1.77 [P < .001]），接受非手术治疗的患者（vs内固定：RR，1.48; 95% CI，1.45-1.51 [P < .001]），患者年龄大于90岁（与≥ 75岁相比：RR，1.42; 95%CI，1.37-1.46 [P <0.001]）。结论和相关性在疗养院居民中，髋部骨折后的存活率和功能结果较差，特别是对于接受非手术治疗的患者、年龄最大的老年人以及患有多种合并症和晚期认知障碍的患者。护理计划应纳入与该人群结局相关的适当预后信息。
IMPORTANCE Little is known regarding outcomes after hip fracture among long-term nursing home residents.OBJECTIVE To describe patterns and predictors of mortality and functional decline in activities of daily living (ADLs) among nursing home residents after hip fracture.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of 60 111 Medicare beneficiaries residing in nursing homes who were hospitalized with hip fractures between July 1, 2005, and June 30, 2009.MAIN OUTCOMES AND MEASURES Data sources included Medicare claims and the Nursing Home Minimum Data Set. Main outcomes included death from any cause at 180 days after fracture and a composite outcome of death or new total dependence in locomotion at the latest available assessment within 180 days. Additional analyses described within-residents changes in function in 7 ADLs before and after fracture.RESULTS Of 60 111 patients, 21 766 (36.2%) died by 180 days after fracture; among patients not totally dependent in locomotion at baseline, 53.5% died or developed new total dependence within 180 days. Within individual patients, function declined substantially after fracture across all ADL domains assessed. In adjusted analyses, the greatest decreases in survival after fracture occurred with age older than 90 years (vs >= 75 years: hazard ratio [HR], 2.17; 95% CI, 2.09-2.26 [P < .001]), nonoperative fracture management (vs internal fixation: HR for death, 2.08; 95% CI, 2.01-2.15 [P < .001]), and advanced comorbidity (Charlson score of >= 5 vs 0: HR, 1.66; 95% CI, 1.58-1.73 [P < .001]). The combined risk of death or new total dependence in locomotion within 180 days was greatest among patients with very severe cognitive impairment (vs intact cognition: relative risk [RR], 1.66; 95% CI, 1.56-1.77 [P < .001]), patients receiving nonoperative management (vs internal fixation: RR, 1.48; 95% CI, 1.45-1.51 [P < .001]), and patients older than 90 years (vs >= 75 years: RR, 1.42; 95% CI, 1.37-1.46 [P < .001]).CONCLUSIONS AND RELEVANCE Survival and functional outcomes are poor after hip fracture among nursing home residents, particularly for patients receiving nonoperative management, the oldest old, and patients with multiple comorbidities and advanced cognitive impairment. Care planning should incorporate appropriate prognostic information related to outcomes in this population.