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a Department of Epidemiology and Preventive Medicine, University of Maryland, Baltimore
b School of Social Work, University of North Carolina at Chapel Hill
c Managed EDGE/EURO RSCG, New York, New York
d Sinai Rehabilitation Center, Baltimore, Maryland
e Division of Orthopedic Surgery, University of Maryland Medical System, Baltimore
Jay Magaziner, Department of Epidemiology and Preventive Medicine, University of Maryland Medical System, Division of Gerontology, 660 West Redwood Street, Suite 200, Baltimore, MD 21201-1596 E-mail: jmagazin{at}epi.umaryland.edu.
Decision Editor: John E. Morley, MB, BCh
Background. This report describes changes in eight areas of functioning after a hip fracture, identifies the point at which maximal levels of recovery are reached in each area, and evaluates the sequence of recuperation across multiple functional domains.
Methods. Community-residing hip fracture patients (n = 674) admitted to eight hospitals in Baltimore, Maryland, 1990–1991, were followed prospectively for 2 years from the time of hospitalization. Eight areas of function (i.e., upper and lower extremity physical and instrumental activities of daily living; gait and balance; social, cognitive, and affective function) were measured by personal interview and direct observation during hospitalization at 2, 6, 12, 18, and 24 months. Levels of recovery are described in each area, and time to reach maximal recovery was estimated using Generalized Estimating Equations and longitudinal data.
Results. Most areas of functioning showed progressive lessening of dependence over the first postfracture year, with different levels of recovery and time to maximum levels observed for each area. New dependency in physical and instrumental tasks for those not requiring equipment or human assistance prefracture ranged from as low as 20.3% for putting on pants to as high as 89.9% for climbing five stairs. Recuperation times were specific to area of function, ranging from approximately 4 months for depressive symptoms (3.9 months), upper extremity function (4.3 months), and cognition (4.4 months) to almost a year for lower extremity function (11.2 months).
Conclusions. Functional disability following hip fracture is significant, patterns of recovery differ by area of function, and there appears to be an orderly sequence by which areas of function reach their maximal levels.
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