Combined Effects of Cognitive Impairment and Nutritional Trajectories on Functional Recovery for Older Patients after Hip-Fracture Surgery |
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| Institution: | 1. Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan;2. School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan;3. Department of Neurology, Dementia Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan;4. Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan;5. Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;6. Department of Emergency Medicine, Linkou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan;7. Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan;8. Center for Quality Management, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan;9. Department of Gerontological Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;10. Department of Nursing, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan;1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;2. School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada;3. Department of Family and Community Medicine, University of Toronto, Ontario, Canada;4. Department of Geriatrics, Florida State University College of Medicine, Tallahassee, FL, USA;1. Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, Rochester, NY;2. Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY;3. University of North Carolina, Chapel Hill, NC, USA;1. Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, MA, USA;2. Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;3. Surgical Services, Shriners Hospitals for Children, Boston, MA, USA;4. Sumner Redstone Burn Center, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA;1. School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan City, Shandong Province, China;2. School of Physical Education, Shandong University, Jinan City, Shandong Province, China;1. Aging Clinical Research, Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany;2. Center for Molecular Medicine, University of Cologne, Cologne, Germany;3. Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany;4. CECAD, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany;1. Hopkins ElderPlus and Johns Hopkins University, Baltimore, MD, USA;2. National PACE Association, Alexandria, VA, USA;3. Neighborhood PACE, East Boston Neighborhood Health Center, East Boston, MA, USA;4. National PACE Association, Alexandria, VA, USA;5. Providence ElderPlace, Portland, OR, USA;6. University of Pennsylvania, Philadelphia, PA, USA |
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| Abstract: | ObjectivesMalnutrition and cognitive impairment are associated with poor functional recovery in older adults following hip-fracture surgery. This study examined the combined effects of cognitive impairment and nutritional trajectories on postoperative functional recovery for older adults following hip-fracture surgery.DesignProspective longitudinal correlational study.Setting and ParticipantsThis study recruited 350 older adults (≥60 years of age) who received hip-fracture surgery at a 3000-bed medical center in northern Taiwan from September 2012 to March 2020.MethodsParticipant data were collected over a 2-year period after surgery for nutritional and cognitive status and activities of daily living (ADLs). Participants were grouped by type of nutritional trajectory using group-based trajectory modeling. Generalized estimating equations analyzed associations between trajectory groups/cognitive status at discharge and performance of ADLs.ResultsNutritional trajectories best fit a 3-group trajectory model: malnourished (19%), at-risk of malnutrition (40%), and well-nourished (41%). Nutritional status for the malnourished group declined from 12 months to 24 months following surgery; nutritional status remained stable for at-risk of malnutrition and well-nourished groups. Interactions for cognitive impairment-by-nutritional status were significant: the malnourished + intact cognition subgroup had significantly better ADLs than the malnourished + cognitive impairment subgroup (b = 27.1, 95% confidence interval = 14.0–40.2; P < .001). For at-risk of malnutrition and well-nourished groups, there were no significant differences between cognitive impairment and intact cognition in ADLs. These findings suggest that nutritional status may buffer the negative effect of cognitive impairment on ADLs.Conclusions and ImplicationsBetter nutritional status over time for older adults following hip fracture can protect against adverse influences of cognitive impairment on ADLs during postoperative recovery. Participants with malnutrition and cognitive impairment had the poorest ADLs. These findings suggest interventions tailored to improving nutritional status may improve recovery for older adults following hip-fracture surgery. |
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| Keywords: | Activities of daily living cognitive impairment hip-fracture surgery malnutrition nutritional trajectory |
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