Outcomes of Nonagenarian Patients After Rehabilitation Following Hip Fracture Surgery

OBJECTIVE: Hip fractures (HF) are a growing cause of death and disability among older people, especially in the very old. Although the incidence of these events increases with age and nonagenarians represent a population at high risk, few studies selectively focused on these patients and on their potential to recover gait ability after HF. The aim of this study was to describe the clinical, biological, cognitive, and functional characteristics of a population of HF patients aged 90 years or older, to examine their functional recovery in gait (with or without aids), in-hospital mortality and destination at discharge, and, finally, to assess their 1-year survival according to the functional status achieved at discharge. DESIGN: Retrospective study. SETTING: Department of Rehabilitation and Aged Care. PARTICIPANTS: Seventy-six nonagenarians admitted to a department of rehabilitation after HF surgery. MEASUREMENT: Patients underwent a multidimensional assessment on admission and at discharge. Outcome measures at discharge were the global scores of Tinetti and the Barthel Index, the score at the transferring and walking subitems of the Barthel Index, and the independence to walk with or without aids. Furthermore, we assessed the rate of discharge to home after rehabilitation and the rate of in-hospital death. Logistic regressions were used to assess clinical variables associated with the inability to walk at discharge. Postdischarge 12-month survival was assessed with Kaplan Meyer analysis and compared with Cox proportional hazard regression models, adjusted for confounders. INTERVENTION: A standardized rehabilitation treatment of 2 sessions (40 minutes per session) daily from Monday to Friday and of 1 session on Saturday that included exercises of strengthening, transfers, postural and gait training, and adaptive equipment training. RESULTS: Five patients died during their admission to the department. Among the 71 survivors, 84.5% were able to walk at discharge with an assistive device, either a cane or a walker. Comorbidity and prefracture Barthel Index global score were the only 2 variables associated with the failure to be independent in walking at discharge. At 1 year, mortality was significantly higher for those patients who did not recover walking ability after rehabilitation. CONCLUSION: A large proportion of nonagenarians are able to achieve independence in walking ability (with assistive device) after rehabilitation following HF surgery. The achievement of this ability after rehabilitation is also an important prognostic factor for 1-year survival.