Factors Affecting Functional Recovery After Hip Fracture in the Elderly

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Abstract
Hip fracture is a common condition in the elderly, because of both reduced bone strength and high risk of falling. Excess mortality after hip fractures ranges from 10% to 30%. In the survivors the restoration of function is often poor, despite successful surgical operation. The aim of this article is to review the factors associated with functional prognosis after hip fracture in the elderly. I conducted a Medline search of articles published in the English language literature from 1993 to January, 2004. All of the studies that showed an association between at least one prognostic factor and functional outcome after hip fracture were reviewed. Evaluations of functional outcome included at least one among the following: ambulation, mobility, activities of daily living (ADL), living status, and quality of life. Substantial evidence supported a negative prognostic role of older age, cognitive impairment, impaired prefracture status, and various comorbidities. Consistent evidence from a limited number of studies indicated that poorer social support, depression, pain, delirium, and pressure ulcers were associated with worse functional recovery. Muscle strength assessed postoperatively was associated with a better functional outcome in a few studies assessing small samples of patients. Two studies showed that bowel and/or bladder control was associated with better function. Single studies pointed out a positive association between either bone mineral density or vitamin D status and functional outcome, and a negative association between previous employment in a prestigious occupation and functional outcome. Conflicting data were reported on the prognostic role of gender, hip-fracture type, time of surgery, and type of both anesthesia and surgical operation, with the exception of cemented prostheses that were associated with better function than uncemented prostheses. Limited data excluded a prognostic role of both previous hip fractures and concomitant fractures of an upper limb. In conclusion, a major prognostic role in functional recovery after hip fracture was played by patient-related factors, whereas a marginal role (if any) was played by both fracture-related and surgery-related factors.

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