Hip fracture mortality increases with even mild cognitive decline

By Laura Cowen

Patients with just mild-to-moderate cognitive impairment have a high risk for nursing home admission and mortality during the first year after hip fracture, researchers report.

This finding extends previous research showing that hip fracture patients with post-surgery delirium or dementia were at increased risk for death and nursing home admission after hip fracture, remark Heike Bischoff-Ferrari (University of Zurich, Switzerland) and colleagues in Bone.

They evaluated the rates of mortality and nursing home admission in the year following hip fracture in 173 patients aged 65 years and older (mean 84 years; 79% women).

Of the patients, 94 (54%) had mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score of 15-24), the remainder were cognitively normal (MMSE ≥25).

Bischoff-Ferrari and co-authors report that during the 12-month follow-up period, 20 (27%) patients died and 47 (35%) of the 134 living at home prior to the fracture were subsequently admitted to a nursing home.

After adjustment for confounders including age, gender, body mass index (BMI) , comorbidity, and vitamin D status, the researchers found that patients with mild-to-moderate cognitive impairment had a significant 5.8 times higher risk for death, and a 7.4 times higher risk for being admitted to a nursing home compared with patients with normal cognitive function.

In addition, the analysis showed that men were 2.5 times more likely to die than women, and patients with a low BMI (<22 kg/m²) were 7.3 times more likely to die than those with a high BMI (≥25 kg/m²), independent of cognitive function.

Conversely, each 1 ng/mL increase in baseline 25-hydroxyvitamin D level was associated with a significant 7% reduction in risk for death.

Bischoff-Ferrari and colleagues say that this finding is clinically relevant because 80% of the study participants had vitamin D deficiency. "Independent of cognitive function, it may be warranted to correct vitamin D deficiency in these patients to reduce their risk for mortality," they say.

The team concludes : "Efforts of post-hip fracture care may [need to] include cognitive function assessment to identify high risk individuals."

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