|NARDI, MARLIS - City Hospital Waid|
|FISCHER, KARINA - University Hospital Zurich|
|DAWSON-HUGHES, BESS - Jean Mayer Human Nutrition Research Center On Aging At Tufts University|
|ORAV, ENDEL - Harvard University|
|MEYER, OTTO - University Of Zurich|
|MEYER, URSINA - University Of Zurich|
|BECK, SACHA - City Hospital Waid|
|SIMMEN, HANS-PETER - University Hospital Zurich|
|PAPE, HANS CHRISTOPH - University Hospital Zurich|
|EGLI, ANDREAS - University Of Zurich|
|WILLETT, WALTER - Harvard University|
|THEILER, ROBERT - University Of Zurich|
|BISCHOFF-FERRARI, HEIKE - University Of Zurich|
Submitted to: Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/15/2018
Publication Date: 2/1/2018
Citation: Nardi, M., Fischer, K., Dawson-Hughes, B., Orav, E.J., Meyer, O.W., Meyer, U., Beck, S., Simmen, H., Pape, H., Egli, A., Willett, W.C., Theiler, R., Bischoff-Ferrari, H.A. 2018. Association between caregiver role and short- and long-term functional recovery after hip fracture: a prospective study. Journal of the American Medical Directors Association - Post-Acute and Long Term Care Medicine. 19(2):122-129. https://doi.org/10.1016/j.jamda.2017.08.009.
Interpretive Summary: Hip fractures are the most frequent fractures among seniors age 75 and older, and hip fractures have serious consequences. In the first 12 months after a hip fracture, 10% of patients fracture their other hip, 30% are re-admitted to acute care for any reason, 50% are left with permanent functional disabilities, 25% require long-term care, and 10-25% die. Prior research suggests that enhanced personal control and responsibility among seniors has a positive impact on physical activity, cognitive function, and reduction in mortality. This study was done to evaluate whether seniors who are in a caregiver role have better functional recovery after hip fracture compared to non-caregivers. In 107 seniors, mean age 83 years, we assessed the timed up-and-go (TUG,) a test of physical function, 12 days after surgery for hip fracture (considered baseline) and again 6 and 12 months later. At all three time points, the TUG test was better in caregivers than in non-caregivers. In conclusion, having a caregiver role appears to have a favorable impact on recovery after hip fracture. Clinicians should, therefore, be aware of the influence of personal control and enhanced responsibility on the convalescence after a hip fracture and should integrate this knowledge in the follow-up care.
Technical Abstract: After a hip fracture, 50% of senior patients are left with permanent functional decline and 30% lose their autonomy. The aim of this prospective study was to evaluate whether seniors who are in a caregiver role have better functional recovery after hip fracture compared with non-caregivers. We investigated 132 patients with acute hip fracture age 65 and older (85% women, 83.8 +/- 6.9 years, 79% community-dwelling) and measured lower extremity mobility with the Timed Up and Go test (TUG) in seconds at baseline during acute care and at 6- and 12-months follow-up after hip fracture repair. At baseline, participants were asked if they were caregivers for a person, a pet, or a plant. Differences in TUG performance between caregivers and non-caregivers at 6 and 12 months were assessed using multivariable repeated-measures analysis adjusted for age, gender, BMI, Charlson comorbidity index, mini-mental state examination, living condition, baseline TUG, and treatment (vitamin D, home exercise program as part of the original trial). At baseline, TUG performance was better in caregivers of any kind compared with non-caregivers (34.8 vs. 71.7 sec, P < 0.0001). At 6 months, TUG was better in caregivers of any kind (-6.8 sec, P = 0.007) and caregivers of plants (-6.9 sec, P = 0.003) compared with non-caregivers. At 12 months, only caregivers of persons had better TUG performance compared with non-caregivers (-7.6 sec, P = 0.009). In conclusion, senior hip fracture patients who have a caregiver role of any kind, and especially plants, have better short-term recovery after hip fracture assessed with the TUG test. For long-term recovery, senior hip fracture patients who are caregivers for other persons appeared to have a significant benefit. These benefits were independent of baseline function and all other covariates.