Effect of cognitive impairment on basic activities of daily living in hip fracture patients: a 1-year follow-up.

Background And Aims: To compare changes in basic self-care activities in various cognitive groups of hip fracture patients by the Katz Index of Independence in activities of daily living (ADL).

Methods: 117 community-dwelling elderly subjects with acute hip fracture (age 67-92 years), referred to the geriatric unit of Jyväskylä Central Hospital for rehabilitation, participated in the study. Basic self-care activities were evaluated by the Katz ADL Index and cognition by the Mini-Mental State Examination (MMSE).

Results: Prior to hip fracture, the patients in the lowest MMSE group had a significantly lower Katz Index than the other three groups (p<0.001). Disability increased in a statistically significantly way post-surgery in all four MMSE groups (p<0.001). In the two lower MMSE groups, the Katz Index remained at the lower level, and in the two higher groups it improved in a statistically significant way from 2 weeks to 3 months post-operatively, after which it deteriorated slightly. A significantly larger proportion of patients in the higher MMSE groups were independent in all basic ADLs, both before and after fracture (from p=0.023 to p<0.001), except in continence prior to fracture.

Conclusions: Prior to hip fracture, patients with low MMSE scores had a significantly greater degree of basic ADL dependence than the other three groups. Despite similar post-operative multidisciplinary treatment, functional ability remained at the lower level in the two lower MMSE groups, whereas recovery was much better in the higher MMSE groups.