Early Predictors for Discharge to Geriatric Rehabilitation after Hip Fracture Treatment of Older Patients

ObjectiveTo investigate early predictors for discharge to a geriatric rehabilitation department at a skilled nursing home in older patients after hospitalization for hip fracture surgery.DesignRetrospective cohort study.Setting and ParticipantsData from 21,176 patients with hip fracture aged ≥70 years, who were registered in the Dutch Hip Fracture Audit database between January 1, 2017, and December 31, 2019, were included.MethodsPatients were categorized into 3 discharge groups: home (n=7326), rehabilitation (n=11,738), and nursing home (n=2112). Age, gender, Pre-Fracture Mobility Score (PFMS), premorbid Katz index of independence in Activities of Daily Living (Katz-ADL), history of dementia, American Society of Anesthesiologists physical status classification (ASA score), type of anesthesia, fracture type, surgical treatment, and cotreatment by a geriatrician were gathered. Multinomial regression analysis was used to assess for early predictors.ResultsHigher age, poor premorbid mobility, lower premorbid Katz-ADL, no history of dementia, ASA score 3-5, general anesthesia, intramedullary implant, and cotreatment by a geriatrician were independent predictors for discharge to geriatric rehabilitation vs discharge home. Identical predictors were found for discharge to a nursing home vs discharge home. History of dementia and premorbid Katz-ADL were distinguishing factors; a higher premorbid Katz-ADL and a history of dementia were associated with a higher risk of discharge to a nursing home vs discharge home. The multinomial regression model correctly predicted 86%, 38.6%, and 2.4% of the patients in the rehabilitation group, home group, and nursing home group, respectively.Conclusions and ImplicationsThis study showed that age, PFMS, premorbid Katz-ADL, surgical treatment, ASA score, type of anesthesia, history of dementia, and cotreatment by a geriatrician were independent early predictors for discharge to geriatric rehabilitation vs discharge home in older patients after hip fracture surgery. Identical predictors were found as predictors for discharge to a nursing home vs discharge home, except for history of dementia and premorbid Katz-ADL.     

Independent,Differential Effects of Delirium on Disability and Mortality Risk After Hip Fracture

ObjectivesTo assess the independent effect of delirium on mortality and disability after 1 year of follow-up, in consecutive older patients with hip fracture hospitalized for surgical repair.DesignThis is a prospective observational study.Setting and ParticipantsPatients aged older than 65 years consecutively admitted for hip fracture to the Trauma and Orthopedics Centre of a third-level hospital, between March and October 2014.MethodsPatients were evaluated by a multidisciplinary team. A comprehensive geriatric assessment was performed on admission. Delirium was assessed before and after surgical repair according to the Confusion Assessment Method. Mortality and disability status were collected at 3 months and 1 year after hospital discharge.ResultsOf 411 patients with hip fracture, 387 (mean age 82 years, female 72%) were enrolled. Delirium was assessed in 50% of the enrolled population. Patients with delirium were older, frequently affected by dementia, severe prefracture disability, history of falls, and polypharmacy. One-year mortality was 19% in all populations, and higher in patients with delirium, although delirium did not show an independent association with mortality, in multivariable analysis. Conversely, delirium was identified as an independent prognostic factor of long-term disability (B-1.605, SE 0.211, P < .001).Conclusion and ImplicationsThis study identifies delirium as an independent long-term disability generator, regardless of associated clinical conditions and premorbid cognitive and functional status. This emphasises the importance of delirium prevention through a multidisciplinary approach and the potential role of systematic treatment of risk factors in reducing functional decline, even in subjects with preexistent disability and dementia. Moreover, these data call for research on rehabilitation interventions specifically targeted to these complex patients, with the aim of identifying approaches effective in reducing long-term disability. Conversely, a high level of clinical alertness is required in patients with delirium, as an appropriate treatment of acute diseases should reduce their high mortality risk.     

Nutritional Therapy in Older Patients With Hip Fractures Undergoing Rehabilitation: A Systematic Review and Meta-Analysis

ObjectiveOlder people with hip fractures are often undernourished, which adversely affects their functional prognosis. A previous review reported that oral multinutritional supplements may prevent complications after hip fracture surgery. However, it is unclear whether interventions that combine rehabilitation and nutritional therapy have prognostic benefits. The objective of this study was to determine whether nutritional therapy is effective for patients with hip fractures undergoing rehabilitation.DesignSystematic literature review and meta-analysis.Setting and ParticipantsRandomized controlled trials involving patients at least 65 years of age with hip fracture undergoing rehabilitation with or without nutritional therapy. Older patients with hip fractures undergoing rehabilitation were included.MethodsA systematic literature search using 5 databases (PubMed, Cochrane Central Register of Controlled Trials, EMBASE, WHO ICTRP, and Ichu-shi Web) was conducted in December 2018 and identified all randomized controlled trials. Outcome variables include mortality, complications, activities of daily living, quality of life, and muscle strength.ResultsOf the 1431 studies found, 10 met the inclusion criteria, involving a total of 1119 patients. Four studies reported mortality, 5 studies reported complications, and 4 studies reported grip strength. Nutritional therapy showed a significant reduction in mortality [relative risk (RR) 0.61, 95% confidence interval (CI) 0.39, 0.93; I² = 0%] and complications (RR 0.67, 95% CI 0.44, 1.03; I² = 79%), and improved grip strength (mean difference = 2.01, 95% CI 0.81, 3.22; I² = 0%). The effects of nutritional therapy on activities of daily living, quality of life, and knee extension strength are unknown. The majority of studies were assessed as low quality.Conclusions and ImplicationsOur study showed that the combination of rehabilitation and nutritional therapy for older patients with hip fractures reduced mortality and postoperative complications and enhanced grip strength, although the quality of the evidence was low. A well-designed controlled study is needed for further investigation.     

老年人髋部骨折术后并发症预防及康复护理

随着人口老龄化的迅速发展，生活水平的提高，长寿之人也随之增多，老年人髋部骨折临床较多见，主要包括股骨颈及股骨粗隆间骨折。人工髋关节置换术、DHS及PFNA已被认为是治疗老年人髋部骨折的最佳治疗手段。其除了能改善患者关节活动度及稳定性外，还能够有效地缓解疼痛，提高肢体的功能状态，改善总体生存质量。老年人髋部骨折术后并发症包括感染、坠积性肺炎，肺栓塞、髋关节脱位、下肢静脉血栓形成、褥疮等，及时的处理、预防，减少并发症及康复护理是骨科治疗和护理的重要部分，护理人员必须运用科学的方法，对不同患者，不同训练时期的康复训练有针对性指导，并加强与医生、患者及家属的沟通，才能保证病人手术的成功。此外还要掌握老年人护理的特殊性，从而提高老年人护理工作效果，使这类病人术后得到早日康复。     

Risk Analysis for Second Hip Fracture in Patients After Hip Fracture Surgery: A Nationwide Population-Based Study

Objectives

The current treatment program for fragility hip fractures (HFx) emphasizes a combination of early surgery, rehabilitation, and tertiary prevention strategy for osteoporosis; however, the effect is unclear and little information is available on the risk factors predicting the occurrence of a second hip fracture (SHFx). The aim of this study was to explore the incidence, risk factors, and subsequent mortality of SHFx in patients after their first hip fracture surgery (HFxS).

Design, Setting, and Participants

We performed a nationwide population-based longitudinal observational study using the National Health Insurance Research Database (NHIRD) of Taiwan with a logistic regression model analysis. Of 87,415 patients undergoing HFxS during the period 2004 to 2007, we identified 8027 patients who had sustained an SHFx for analyses.

Measurements

Data collected included patient characteristics (demographics, comorbidities, and concurrent medication use), incidence and hazard ratios of SHFx after HFxS, and subsequent age-specific mortality.

Results

The overall incidence of SHFx was 9.18% and the age-specific mortality was increased 1.6- to 2.2-fold in patients with SHFx compared with those without after HFxS in this 7-year longitudinal study. The identified risk factors included age (AOR = 1.84, 95% CI: 1.24–2.89), female gender (AOR = 1.12, 95% CI: 1.03–2.30), obesity (AOR = 2.89, 95% CI: 1.81–3.01), diabetes (AOR = 3.85, 95% CI: 2.54–4.05), arterial hypertension (AOR = 2.45, 95% CI: 1.83–2.62), hyperlipidemia (AOR = 2.77, 95% CI: 1.27–3.19), stroke/TIA (AOR = 2.85, 95% CI: 2.20–3.23), blindness/low vision (AOR = 3.09, 95% CI: 2.54–3.73), and prolonged use of analgesics and anti-inflammatory medications (all AOR ≥ 3.05, all P values ≤.012). Bisphosphonate therapy after HFxS had a significant negative risk association with the development of an SHFx (20.8% vs 32.3%, P = .023; AOR = 2.24, 95% CI: 1.38–2.90).

Conclusion

We concluded that the occurrence of an SHFx and subsequent mortality in patients after HFxS is rather high. An understanding of the risk factors predicting the occurrence of an SHFx provides a valuable basis to improve health care for geriatric populations.     

Calf Circumference,a Valuable Tool to Predict Sarcopenia in Older People Hospitalized with Hip Fracture

Sarcopenia is an important risk factor for hip fracture in older people. Nevertheless, this condition is overlooked in clinical practice. This study aimed to explore the factors associated with sarcopenia among older patients hospitalized for hip fracture, to identify a predictive model of sarcopenia based on variables related to this condition, and to evaluate the performance of screening tools in order to choose the most suitable to be adopted in routine care of older people with hip fracture. A cross-sectional study was undertaken with 90 patients (mean age 83.4 ± 7.2 years), by assessing sociodemographic and clinical characteristics, anthropometric measures, such as body mass index (BMI) and calf circumference (CC), the functional status (Barthel Index), the nutritional status (MNA-SF), and the adherence to the Mediterranean Diet (MEDAS). Diagnosis of sarcopenia was established according to the criteria of the European Working Group on Sarcopenia in Older People (EWGSOP2). The analysis of variables associated with sarcopenia was performed using multivariate logistic regression models. Clusters of sarcopenia were explored with heatmaps and predictive risk models were estimated. Sarcopenia was confirmed in 30% of hip fracture patients. Variables with the strongest association with sarcopenia were BMI (OR = 0.79 [0.68–0.91], p < 0.05) and CC (OR = 0.64 [0.51–0.81], p < 0.01). CC showed a relatively high predictive capacity of sarcopenia (area under the curve: AUC = 0.82). Furthermore, CC could be a valuable tool to predict sarcopenia risk compared with the currently used screening tools, SARC-F and SARC-CalF (AUC, 0.819 vs. 0.734 and 0.576, respectively). More studies are needed to validate these findings in external study populations.     

Post-Acute Care Setting After Hip Fracture Hospitalization and Subsequent Opioid Use in Older Adults

ObjectivePain management in post-acute care (PAC) requires careful balance, with both opioid use and inadequate pain treatment linked to poor outcomes. We describe opioid use among older adults following discharge from PAC for hip fracture in skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs).DesignRetrospective cohort.Setting and ParticipantsMedicare beneficiaries with Medicare Provider Analysis (MedPAR) claims, aged 66 years and older with a hip fracture hospitalization between 2012 and 2018 followed by PAC in SNFs or IRFs and then discharge to the community.MethodsIndividuals were followed from PAC discharge for up to 1 year to assess opioid use. Covariate-standardized risk ratios (RR) and risk differences (RD) for opioid use within 7 days of PAC discharge were estimated via parametric g-formula with modified Poisson regression, and hazard ratios (HRs) for any post-PAC opioid use and long-term opioid use via Fine-Gray sub-distribution hazards regression.ResultsOf 101,021 individuals, 80% (n = 80,495) were discharged from SNFs and 20% (n = 20,526) from IRFs. Opioids were dispensed to 50,433 patients (50%) overall and the 1-year cumulative incidence was notably higher in IRF (68%) than SNF (46%) patients. The adjusted risk of discharge from PAC with an opioid was 41% lower after SNFs versus IRFs [RR: 0.59; 95% confidence limits (CLs): 0.57–0.61; and RD: −0.16; 95% CLs: −0.17 to −0.15]. The adjusted rate of any opioid use in the year after PAC discharge was 44% lower (HR: 0.56; 95% CLs: 0.54–0.57) and of long-term opioid use was 17% lower (HR: 0.83; 95% CLs: 0.80–0.87) after SNFs versus IRFs.Conclusions and ImplicationsOpioid use is highly prevalent upon discharge from PAC after hip fracture, with lower use after SNF versus IRF care. Future research should assess the benefits and harms of post-PAC opioid prescribing and whether care practices during PAC can be improved to optimize long-term opioid use.     

Postoperative Dehydration Is Associated with Frailty and Decreased Survival in Older Patients with Hip Fracture

Background: Hyperosmolar dehydration (HD) is a risk factor for severe complications in hip fracture in older patients. However, evidence for recommending screening of dehydration is insufficient and its relation with frailty and mortality is unclear. We tested the hypothesis that postoperative HD is associated with frailty and increased mortality. Methods: We recruited 625 older (>65 years) patients surgically treated for hip fracture and co-managed by an orthogeriatric team over one year in 2017. Pre- and postoperative HD (serum osmolarity > 300 mmol/L) was diagnosed. Frailty and associated mortality risk were assessed by the Multidimensional Prognostic Index (MPI). Results: The prevalence of preoperative HD was 20.4%. Compared with no-HD, MPI was similar in HD patients despite higher (p < 0.05) prevalence of polypharmacy, arterial hypertension, diabetes, chronic kidney disease and heart failure. After surgery the incidence of HD decreased to 16.5%, but increased (p = 0.003) in the MPI high-risk subgroup. Postoperative HD was associated with more complications and was an independent determinant of adjusted hospital length of stay (LOS) and of 60- to 365-days mortality. Conclusions: Older frail patients with hip fracture are prone to developing postoperative HD, which independently predicts prolonged hospital LOS and mortality. Systematically screening older patients for frailty and dehydration is advisable to customize hydration management in high-risk individuals.     

Muscle Thickness and Echogenicity Measured by Ultrasound Could Detect Local Sarcopenia and Malnutrition in Older Patients Hospitalized for Hip Fracture

Background: The aim of this work was to assess whether the muscle thickness and echogenicity were associated with dysphagia, malnutrition, sarcopenia, and functional capacity in acute hospital admission for a hip fracture. Methods: Observational study that assessed nutritional status by Global Leadership Initiative on Malnutrition, risk of dysphagia and sarcopenia by European Working Group on Sarcopenia in Older People and Barthel functional index. We measured muscle thickness and echogenicity of masseter, bicipital, and quadriceps rectus femoris (RF) and vastus intermedius (VI) by ultrasound. Results: One hundred and one patients were included in the study (29.7% sarcopenia and 43.8% malnutrition). Logistic regression models adjusted for age, sex, and body mass index showed an inverse association of the masseter thickness with both sarcopenia (OR: 0.56) and malnutrition (OR: 0.38) and quadriceps with sarcopenia (OR: 0.74). In addition, patients at high risk of dysphagia had lower masseter thickness (p: 0.0001) while patients able to self-feeding had thicker biceps (p: 0.002) and individuals with mobility on level surfaces higher thickness of biceps (p: 0.008) and quadriceps (p: 0.04). Conclusion: Thickness of the masseter was associated with risk of dysphagia, biceps with the ability to self-feed, and that of the quadriceps RF-VI with mobility.     

Translating Research into Practice Intervention Improves Management of Acute Pain in Older Hip Fracture Patients

Objective. To test an interdisciplinary, multifaceted, translating research into practice (TRIP) intervention to (a) promote adoption, by physicians and nurses, of evidence-based (EB) acute pain management practices in hospitalized older adults, (b) decrease barriers to use of EB acute pain management practices, and (c) decrease pain intensity of older hospitalized adults.
Study Design. Experimental design with the hospital as the unit of randomization.
Study Setting. Twelve acute care hospitals in the Midwest.
Data Sources. (a) Medical records (MRs) of patients ≥65 years or older with a hip fracture admitted before and following implementation of the TRIP intervention and (b) physicians and nurses who care for those patients.
Data Collection. Data were abstracted from MRs and questions distributed to nurses and physicians.
Principal Findings. The Summative Index for Quality of Acute Pain Care (0–18 scale) was significantly higher for the experimental (10.1) than comparison group (8.4) at the end of the TRIP implementation phase. At the end of the TRIP implementation phase, patients in the experimental group had a lower mean pain intensity rating than those in the comparison group (  p <.0001).
Conclusion. The TRIP intervention improved quality of acute pain management of older adults hospitalized with a hip fracture.     

Comorbidity and Quality of In-Hospital Care for Hip Fracture Patients

ObjectivesWe examined whether the comorbidity burden of patients with hip fracture was associated with quality of in-hospital care reflected by fulfillment of process performance measures.DesignPopulation-based cohort study using prospectively collected data from the Danish Multidisciplinary Hip Fracture Registry (DMHFR).Setting and ParticipantsPatients aged 65 years or older with an incident hip fracture from 2014 to 2018 registered in the DMHFR (n = 31,443).MethodsComorbidity was measured using the Charlson Comorbidity Index based on hospital diagnoses. Quality of in-hospital care was defined as fulfillment of eligible process performance measures, including preoperative optimization, early surgery, early mobilization, pain assessment, basic mobility, nutritional risk, need for anti-osteoporotic medication, fall prevention, and a post-discharge rehabilitation program, reflecting guideline-recommended in-hospital care. The outcomes were (1) an all-or-none composite measure defined as fulfillment of all relevant process performance measures, and (2) fulfillment of the individual process performance measures. Using binary regression, we calculated relative risk (RR) for the association between comorbidity level and outcomes.ResultsThe overall proportion of patients with hip fracture who fulfilled the all-or-none measure was 31%. Among patients with no comorbidity, 34% fulfilled the all-or-none measure versus 29% among patients with high comorbidity (Charlson ≥ 3). This corresponds to a 15% lower chance (RR = 0.85, 95% confidence interval 0.81–0.89). Increasing comorbidity was also associated with lower fulfillment of the individual process performance measures. The largest difference was seen for preoperative optimization, early surgery, and early mobilization, where patients with high comorbidity had 6% to 11% lower chance of fulfillment of these process performance measures compared with patients without comorbidity.Conclusion and ImplicationsIncreasing level of comorbidity was associated with lower quality of in-hospital care among patients with hip fracture. Our results highlight the need for tailored clinical initiatives to ensure that comorbid patients also benefit from the positive progress in hip fracture care in recent years.     

早期康复在老年股骨颈骨折合并偏瘫患者中的效果观察

目的探讨全髋关节置换术后早期康复在股骨颈骨折合并偏瘫患者中的应用效果。方法选取2017年2月-2019年2月本院老年偏瘫侧股骨颈骨折患者68例。分为研究组和对照组,对照组采用常规偏瘫康复,研究组则采用术后早期康复,对比两组患者各项结果。结果术后康复训练3个月和6个月,研究组Harris髋关节评分均高于对照组(P<0.05);研究组Brunnstrom偏瘫运动功能5期以上人数多于对照组(P<0.05);研究组并发症发生率低于对照组(P<0.05),且训练后3个月和6个月,两组均未发生假体移位、松动和下沉的情况。研究组生活质量高于对照组(P<0.05)。结论全髋关节置换术后早期康复有利于提高老年股骨颈骨折合并偏瘫患者的康复,提高生活质量。     

综合护理干预对老年股骨粗隆间骨折患者的效果观察

目的 探讨观察对老年股骨粗隆间骨折患者手术治疗,手术前后给予综合护理干预工作对患者临床的治疗效果。方法 选取医院2019年1月—2020年12月收治的老年股骨粗隆间骨折患者68例,随机分为观察组34例给予综合护理干预,常规组34例给予常规护理,对两组患者护理效果、术后疼痛、髋关节功能评分及护理满意度效果进行对比分析。结果 观察组术后VAS评分明显低于常规组,差异有统计学意义（P <0.05）。护理后观察组SDS和SAS评分明显低于常规组,差异有统计学意义（P <0.05）。护理后观察组Harris评分和Barthel指数均明显提高,观察组明显高于常规组,差异有统计学意义（P <0.05）。观察组并发症发生率为8.82%明显低于常规组的29.41%,差异有统计学意义（P <0.05）。观察组护理满意度94.12%明显高于常规组的76.47%,差异有统计学意义（P <0.05）。结论 对老年股骨粗隆间骨折患者给予护理干预,有利于患者恢复,减轻术后疼痛,改善髋关节功能,提高护理满意度。     

Effect of Lower-Limb Progressive Resistance Exercise After Hip Fracture Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies

Objective

Although several studies have reported the effect of progressive resistance exercise (PRE) after hip fracture surgery, little is known about the functional efficacy of PRE. Thus, we conducted a meta-analysis to evaluate whether PRE can improve (1) mobility and (2) other physical functions in elderly patients after hip fracture surgery.

老年髋部骨折后下肢深静脉血栓形成的预防护理干预

目的探讨护理干预对预防老年髋部骨折后下肢深静脉血栓（DVT）形成的影响。方法将入选的60岁以上髋部骨折患者126例随机分成对照组63例和干预组63例,对照组实行常规治疗及护理,干预组在常规治疗及护理的基础上实施系统的护理干预措施。结果干预组患者发生2例DVT,发生率3.2%,对照组患者发生9例DVT,发生率为14.3%。对照组DVT发生率高于干预组（χ2=4.881,P〈0.05）。结论加强护理干预有利于预防老年髋部骨折患者下肢深静脉血栓的形成,可提高老年患者的生活质量。     

The Impact of COVID-19 on the Prevalence,Mortality, and Associated Risk Factors for Mortality in Patients with Hip Fractures: A Meta-Analysis

ObjectiveThis study aimed to assess (1) the prevalence of COVID-19 in patients with hip fracture; (2) the mortality rate of patients with hip fracture associated with COVID-19; (3) risk factors associated with mortality in patients with hip fracture; and (4) the effects of COVID-19 on surgical outcomes of patients with hip fracture.DesignMeta-analysis.Setting and ParticipantsPatients with hip fractures during COVID-19.MethodsPubMed, Web of Science, and Embase were systematically reviewed. The outcomes included the prevalence of COVID-19, case fatality rate, 30-day mortality, cause of death, risk factors associated with the mortality of patients with hip fracture, time to surgery, surgical time, and length of hospitalization. Risk ratio or weight mean difference with 95% confidence intervals were used to pool the estimates.ResultsA total of 60 studies were included in this meta-analysis. The pooled estimate showed that the prevalence of COVID-19 was 21% in patents with hip fractures. Patients with hip fracture with COVID-19 had an increased 30-day mortality risk compared with those without the infection. The main causes of death were respiratory failure, COVID-19–associated pneumonia, multiorgan failure, and non–COVID-19 pneumonia. The hospitalization was longer in patients with COVID-19 when compared with those without the infection, but was shorter in patients during the pandemic period. The surgery time and time to surgery were not significantly different between patients during or before the pandemic period and in those with or without COVID-19.Conclusions and ImplicationsThe 30-day mortality rate was significantly higher in patients with hip fracture with COVID-19 infection than those without. Patients with COVID-19 had a higher all-cause mortality rate than those without. This information can be used by the medical community to guide the management of patients with hip fracture with COVID-19.     

Risk of Hip Fracture in Benzodiazepine Users With and Without Alzheimer Disease

Objectives

To investigate the association between benzodiazepine and related drug (BZDR) use and hip fracture as well as postfracture mortality and duration of hospital stay in community-dwellers with and without Alzheimer disease (AD).

The Association Between Psychological Resilience and Physical Function Among Older Adults With Hip Fracture Surgery

ObjectivesTo examine the associations of prefracture psychological resilience and prefracture general mental health with physical function among older adults with hip fracture surgery.DesignSingle-center observational study.InterventionNone.Setting and participantsPatients aged ≥50 years who underwent first hip fracture surgery between January 2017 and December 2017 (N = 152).MethodsWe used data collected prospectively from the hospital's hip fracture registry. We performed generalized estimating equations to examine the associations of prefracture psychological resilience (10-item Connor-Davidson Resilience Scale) and prefracture general mental health (Short Form–36 mental health subscale) with physical function (Short Form–36 physical functioning subscale) at 4 time points—prefracture (based on recall), and 1.5, 3, and 6 months after surgery.ResultsPrefracture psychological resilience had an association with physical function; a 1-unit increase in psychological resilience score was associated with 1.15 units [95% confidence interval (CI) 0.71, 1.59] higher physical function score across 4 time points. In contrast, the association between general mental health and physical function varied over time; a 1-unit increase in general mental health score was associated with 0.42 units (95% CI 0.18, 0.66) higher physical function score at prefracture, 0.02 units (95% CI –0.18, 0.22) lower at 1.5 months, 0.23 units (95% CI –0.03, 0.49) higher at 3 months, and 0.39 units (95% CI 0.09, 0.68) higher at 6 months after surgery.Conclusions and implicationsPsychological resilience is associated with physical function among older adults with hip fracture surgery, independent from general mental health. Our findings suggest the potential for interventions targeting psychological resilience for these patients and call for more studies on psychological factors affecting physical function recovery after hip fracture surgery.     

Factors Associated With 30-Day Rehospitalization and Mortality in Older Patients After a Pneumonia Admission

ObjectivesShort-term rehospitalization and mortality are common events in older patients after a pneumonia admission, yet little knowledge exists on how to identify the patients at risk of these events. This knowledge is needed to ensure that health care attention is given to those with the highest needs. We therefore aimed to identify factors of importance for short-term rehospitalization and mortality in older patients after admission for pneumonia.DesignPopulation-based cohort study.SettingThe Danish nationwide registries.ParticipantsIn total, 246,245 individuals aged 65-99 years who experienced 298,564 admissions for pneumonia from 2000 to 2016.MethodsThe explored factors in patients were demographic characteristics, health-seeking behavior, comorbidity, and medication use. A Cox proportional hazards model was used to calculate hazard ratios (HRs) for 30-day rehospitalization and 30-day mortality with 95% confidence intervals (CIs).ResultsOf the 298,564 admissions for pneumonia, 23.0% were rehospitalized and 8.1% died within 30 days of follow-up. Most of the investigated factors were significantly associated with these 2 outcomes. The HRs for rehospitalization ranged from 0.80 (95% CI 0.75-0.85) for old vs young age to 4.29 (95% CI 4.05-4.54) for many vs no prior admissions, whereas the HRs for mortality ranged from 0.87 (95% CI 0.83-0.91) for any vs no practical home care to 5.47 (95% CI 5.08-5.88) for old vs young age. Number of comorbidities, medications, and prior contacts to the health care system were associated with higher risk of both rehospitalization and mortality in a dose-response manner.Conclusions and ImplicationsThis study identified several potential factors of importance for short-term rehospitalization and mortality in older patients discharged after pneumonia. This knowledge can help physicians identify the patients with the highest need of care after admission for pneumonia, thus enabling efficient discharge planning and high-quality provision of care in primary care settings.