Cognitive Impairment as the Principal Factor Correlated with the Activities of Daily Living Following Hip Fracture in Elderly People

OBJECTIVES: Hip fracture is a common injury occurring in elderly people and often impairs their activities of daily living (ADL). This study aimed to identify and analyze factors associated with ADL following hip fracture treatment. METHODS: A total of 371 consecutive patients with hip fractures who were surgically treated in our hospital were enrolled. Among these, 103 patients who underwent acute- to recovery-phase postoperative rehabilitation at our hospital and whose motor scale of the functional independence measure (mFIM) score was ≥70 before the fracture were finally included in this study. Single and multiple regression analyses were performed to identify the factors correlated with ADL. The mFIM at hospital discharge was set as the outcome variable, and various clinical factors, such as fracture type, surgical technique, serum and biological data, mini-mental state examination (MMSE) score, and serial mFIM scores, were used as explanatory variables. RESULTS: Only MMSE and preinjury mFIM scores were significantly correlated with mFIM at discharge, and MMSE had the larger effect on the outcome. Receiver operating characteristic curve analysis revealed an MMSE cutoff value of 20/21. Patients with an MMSE score of ≤20 showed a relatively poor recovery of mFIM from 2–3 weeks postoperatively compared with those with an MMSE score of ≥21. CONCLUSION: Cognitive impairment and the preinjury ADL level were correlated with short-term ADL outcomes following hip fracture. Cognitive impairment was the most important factor affecting ADL; treatment and postoperative rehabilitation should be carefully considered for cognitively disturbed patients from the acute phase after hip fracture.