Falls in community-dwelling older persons following hip fracture: impact on self-efficacy, balance and handicap

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Abstract
Objective: To compare the four-month outcomes of fallers and nonfallers as well as those with slow gait speed in patients with hip fracture successfully discharged back to the community. Design: Prospective study with four-month follow-up data. Setting: Community sample of survivors of hip fracture who have completed their rehabilitation programme. Subjects: A consecutive sample of 73 community-dwelling, cognitively intact older adults admitted to hospital following a fall-related hip fracture and available to complete a follow-up assessment at four months. Main outcome measures: At baseline, data collection consisted of the Modified Barthel Index (MBI), Mini Mental State Examination (MMSE), sociodemographics and medical history. At four months follow-up, data collection consisted of the MBI, London Handicap Scale (LHS), Berg Balance Scale (BBS), a 10-metre timed walk test, Falls Efficacy Scale (FES) and the Activities Balance Confidence (ABC) scale. Participants were also asked to recall if they had fallen in the four months since their fracture. Results: Seventy-three participants had complete data for evaluation. There was minimal disability with a mean MBI of 91.2 but there was some residual handicap with a mean LHS of 0.67. Those who had fallen had lower selfefficacy (FES) and greater handicap (LHS). Those with slower gait speed were more handicapped (LHS), had lower self-efficacy (FES and ABC) and lower balance scores (BBS). Conclusions: Measuring ADL disability alone loses valuable information in community-dwelling survivors of hip fracture. Falls after hip fracture should be a target for treatment and our data give some weight to the idea of a fall fracture cycle. Gait speed, which may re‘ect lower limb strength, is also a target for therapeutic interventions. These measures should be included in clinical practice.