What Factors Are Associated With the Recovery of Autonomy After a Hip Fracture? A Prospective, Multicentric Cohort Study

Abstract

Objective: To identify the factors associated with recovering autonomy in activities of daily living (ADL) in patients who have had a hip fracture.

Design: A prospective cohort study.

Setting: The orthopedic and orthogeriatric departments of 2 regional hospitals.

Participants: Patients (N=742) aged ≥65 years with a diagnosis of fragility hip fracture.

Main outcome measures: The level of autonomy at 4 months was assessed using the ADL scale.

Results: The median score on the ADL scale at 4 months was 3 (interquartile range, 5). Half of the population was unable to recover their prefracture autonomy levels. The following were found to be risk factors: increasing age (B=.02, P<.001); an elevated number of comorbidities (B=.044, P=.005); a lower level of prefracture autonomy (B=.087, P<.001); more frequent use of an antidecubitus mattress (B=.211, P<.001); an increased number of days with disorientation (B=.002, P=.012); failure to recover deambulation (B=.199, P<.001); an increased number of days with diapers (B=.003, P<.001), with a urinary catheter (B=.03, P<.001), and with bed rails (B=.001, P=.014); and a nonintensive care pathway (B=.199, P=.014).

Conclusions: Recovery of deambulation, treatment of disorientation and management of incontinence are modifiable factors significantly associated with the functional recovery of autonomy.

Keywords: Activities of daily living; Hip fractures; Nursing care; Progressive patient care; Rehabilitation.