Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T22:57:38.477Z Has data issue: false hasContentIssue false
  • English
  • Français

Comorbid cognitive impairment and depression is a significant predictor of poor outcomes in hip fracture rehabilitation

Published online by Cambridge University Press:  02 December 2009

Liang Feng ,
Samuel C Scherer ,
Boon Yeow Tan ,
Gribson Chan ,
Ngan Phoon Fong  and
Tze Pin Ng
Liang Feng
Affiliation:
Gerontological Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Samuel C Scherer
Affiliation:
Gerontological Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia
Boon Yeow Tan
Affiliation:
Gerontological Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore St Luke's Hospital, Singapore, Singapore
Gribson Chan
Affiliation:
St Luke's Hospital, Singapore, Singapore
Ngan Phoon Fong
Affiliation:
Gerontological Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Tze Pin Ng*
Affiliation:
Gerontological Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
*
Correspondence should be addressed to: Associate Professor Ng Tze Pin, Gerontological Research Program, National University of Singapore, Department of Psychological Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore119074. Phone: +65-67724514; Fax: +65-67772191. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: The effects of depression and cognitive impairment on hip fracture rehabilitation outcomes are not well established. We aimed to evaluate the associations of depressive symptoms and cognitive impairment (individually and combined) with ambulatory, living activities and quality of life outcomes in hip fracture rehabilitation patients.

Methods: A cohort of 146 patients were assessed on depressive symptoms (Geriatric Depression Scale, GDS ≥ 5), cognitive impairment (Mini-mental State Examination, MMSE ≤ 23), and other variables at baseline, and on ambulatory status, Modified Barthel Index (MBI), and SF-12 PCS and MCS quality of life on follow ups at discharge, 6 months and 12 months post fracture.

Results: In these patients (mean age 70.8 years, SD 10.8), 7.5% had depressive symptoms alone, 28.8% had cognitive impairment alone, 50% had both, and 13.7% had neither (reference). Ambulatory status showed improvement over time in all mood and cognition groups ((β = 0.008, P = 0.0001). Patients who had cognitive impairment alone (β = −0.060, P = 0.001) and patients who had combined cognitive impairment with depressive symptoms β = −0.62, P = 0.0003), showed significantly less improvement in ambulatory status than reference patients. In the latter group, the relative differences in ambulatory scores from the reference group were disproportionately greater over time (β = −0.003, SE = 0.001, P = 0.021). Patients with combined depressive symptoms and cognitive impairment also showed a significantly lower MBI score, (β = −10.92, SE = 4.01, P = 0.007) and SF-12 MCS (β = −8.35, SE = 2.37, P = 0.0006). Mood and cognition status did not significantly predict mortality during the follow-up.

Conclusion: Depression and cognitive impairment comorbidity is common in hip fracture rehabilitation patients and significantly predicts poor functional and quality of life outcomes.

Keywords

depressioncognitive impairmentrehabilitationphysical functioningquality of life
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 2 , March 2010 , pp. 246 - 253
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bellelli, G., Frisoni, G. B., Turco, R. and Trabucchi, M. (2008). Depressive symptoms combined with dementia affect 12-months survival in elderly patients after post-hip fracture surgery. International Journal of Geriatric Psychiatry, 23, 1073–1077.Google Scholar
Boonen, S., Autier, P., Barette, M., Vanderschueren, D., Lips, P. and Haentjens, P. (2004). Functional outcome and quality of life following hip fracture in elderly women: a one-year prospective controlled study. Osteoporosis International, 15, 87–94.Google Scholar
Broekman, B. F. et al. (2008). Differential item functioning of the Geriatric Depression Scale in an Asian population. Journal of Affective Disorders, 108, 285–290.CrossRefGoogle Scholar
Burns, A. et al. (2007). Treatment and prevention of depression after surgery for hip fracture in older people: randomized, controlled trials. Journal of the American Geriatrics Society, 55, 75–80.CrossRefGoogle ScholarPubMed
Charlson, M. E., Pompei, P., Ales, K. L. and MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: prognostic development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Cooper, C. (1997). The crippling consequences of fractures and their impact on quality of life. American Journal of Medicine, 103, 12S–19S.CrossRefGoogle ScholarPubMed
Empana, J. P., Dargent-Molina, P. and Breart, G. (2004). Effect of hip fracture on mortality in elderly women: the EPIDOS prospective study. Journal of the American Geriatrics Society, 52, 685–690.Google Scholar
Evans, M., Hammond, M., Wilson, K., Lye, M. and Copeland, J. (1997). Placebo-controlled treatment trial of depression in elderly physically ill patients. International Journal of Geriatric Psychiatry, 12, 817–824.3.0.CO;2-4>CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.Google Scholar
Gandek, B. et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA (International Quality of Life Assessment) Project. Journal of Clinical Epidemiology, 51, 1171–1178.Google Scholar
Givens, J. L., Sanft, T. B. and Marcantonio, E. R. (2008). Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. Journal of the American Geriatrics Society, 56, 1075–1079.Google Scholar
Hannan, E. L. et al. (2001). Mortality and locomotion 6 months after hospitalization for hip fracture risk factors and risk-adjusted hospital outcomes. JAMA, 285, 2736–2742.Google Scholar
Holmes, J. and House, A. (2000). Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study. Psychological Medicine, 30, 921–929.Google Scholar
Huusko, T. M., Karppi, P., Avikainen, V., Kautiainen, H. and Sulkava, R. (2000). Randomised, clinically controlled trial of intensive geriatric rehabilitation in patients with hip fracture: subgroup analysis of patients with dementia. BMJ, 321, 1107–1111.CrossRefGoogle ScholarPubMed
Inouye, S. K., van Dyck, C. H., Alessi, C. A., Balkin, S., Siegal, A. P. and Horwitz, R. I. (1990). Clarifying confusion: the confusion assessment method – a new method for detection of delirium. Annals of Internal Medicine, 113, 941–948.Google Scholar
Keith, A. R. (1988). Observations in the rehabilitation hospital: twenty years of research. Archives of Physical Medicine and Rehabilitation, 69, 625–631.Google Scholar
Lenze, E. J. et al. (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International Journal of Geriatric Psychiatry, 19, 472–478.CrossRefGoogle ScholarPubMed
Lim, P. P., Ng, L. L., Chiam, P. C., Ong, P. S., Ngui, F. T. and Sahadevan, S. (2000). Validation and comparison of three brief depression scales in an elderly Chinese population. International Journal of Geriatric Psychiatry, 15, 824–830.3.0.CO;2-C>CrossRefGoogle Scholar
Lu-Yao, G. L., Baron, J. A., Barrett, J. A. and Fisher, E. S. (1995). Treatment and survival among elderly Americans with hip fractures: a population-based study. American Journal of Public Health, 84, 1287–1291.Google Scholar
Magaziner, J. et al. (2003). Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. American Journal of Epidemiology, 157, 1023–1031.Google Scholar
Moseley, A. M., Sherrington, C., Lord, S. R., Barraclough, E., St George, R. J. and Cameron, I. D. (2009). Mobility training after hip fracture: a randomized controlled trial. Age and Ageing, 38, 74–80.Google Scholar
Ng, T. P., Niti, M., Chiam, P. C. and Kua, E. H. (2007). Ethnic differences in cognitive performance on Mini-mental State Examination in Asians. American Journal of Geriatric Psychiatry, 15, 130–139.Google Scholar
Nightingale, S., Holmes, J., Mason, J. and House, A. (2001). Psychiatric illness and mortality after hip fracture. The Lancet, 357, 1264–1265.Google Scholar
Nyunt, M. S. Z., Fones, C. S. L., Niti, M. and Ng, T. P. (2009). Criterion-based validity and reliability of the Geriatric Depression Screening Scale (GDS-15) in a large validation sample of community-living Asian older adults. Aging and Mental Health, 13, 376–382.Google Scholar
Perry, J., Garrett, M., Gronley, J. K. and Mulroy, S. J. (1995). Classification of walking handicap in the stroke population. Stroke, 26, 982–989.CrossRefGoogle ScholarPubMed
Robbins, J. A., Biggs, M. L. and Cauley, J. (2006). Adjusted mortality after hip fracture: from the cardiovascular health study. Journal of the American Geriatrics Society, 54, 1885–1891.CrossRefGoogle ScholarPubMed
Shah, S., Vanclay, F. and Cooper, B. (1989a). Improving the sensitivity of the Barthel Index for stroke rehabilitation. Journal of Clinical Epidemiology, 42, 703–709.CrossRefGoogle ScholarPubMed
Shah, S., Vanclay, F. and Cooper, B. (1989b). Predicting discharge status at commencement of stroke rehabilitation. Stroke, 20, 766–769.Google Scholar
Ware, J. E., Kosinski, M. and Keller, S. D. (1996). A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Medical Care, 34, 220–233.CrossRefGoogle ScholarPubMed
Ware, J. E., Kosinski, M. and Keller, S. D. (1998). SF-12®: How to Score the SF-12 ® Physical and Mental Health Summary Scales. 3rd edn. Lincoln, RI: Quality Metric Incorporated.Google Scholar
WHO (2003). Prevention and Management of Osteoporosis. Technical Report Series, No. 921. Geneva: World Health Organization.Google Scholar
Wolinsky, E. D., Eitzgerald, J. E. and Stump, T. E. (1997). The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. American Journal of Public Health, 87, 398–403.CrossRefGoogle ScholarPubMed
Wong, M. K., Arjandas, , Ching, L. K., Lim, S. L. and Lo, N. N. (2002). Osteoporotic hip fractures in Singapore: costs and patient's outcome. Annals of the Academy of Medicine Singapore, 31, 3–7.Google Scholar
Yesavage, J. (1988). Geriatric Depression Scale. Psychopharmacology Bulletin, 24, 709–711.Google Scholar