[Functional status and mortality in the elderly 3 months after hip fracture: when resources are limited].

Abstract

Introduction: hip fracture is the most common fracture in the elderly and its negative impact in functionality, life quality and expectancy are widely described. In Mexico, resources, infrastructure and programs for its attention are few and deficient. Associated factors to a better functional and life prognosis had been described in heterogeneous ways. The main objective of this work is to determine the associated factors to a better functional recovery and less mortality three months after hip fracture in the elderly.

Material and methods: geriatric assessment was performed in all older adult patients admitted to the hospital with hip fracture. Telephone monitoring was done three months after hospital discharge. Survival, Barthel index, and March Capacity Evaluation Scale (FAC) was interrogated. Descriptive analysis of the variables was performed. For outcomes measures, univariate analysis was done, since data didn't have normal distribution. Age and Barthel index before fracture were included in linear regression model to evaluate impact over mortality and march capacity.

Results: three-month mortality was of 26.3% of the patients, with in- hospital hyponatremia as a risk factor (OR, 3.87, p = 0.03). The median difference in pre fracture and post fracture Barthel index was -25 points (-5010). The variables associated with worse functional outcome was patient´s expressed fear to walk again (p = 0.05) and cognitive impairment (p = 0.032). 47.4% of the patients could walk, most of them classified in FAC 4. 28% of the patients, reported walking impairment. Living in urbanity, fear to walk (OR, 4.83, p = 0.031) and malnutrition (OR, 5.52, p = 0.016) were significantly associated with walking impairment.

Conclusions: multifactorial intervention for better functional and survival outcomes three-months after hip fracture are needed, even more in middle-income countries.