Background
Methods
Systematic review of factors associated with functional impairment
Electronic search strategy
Study selection
Definitions of medical conditions associated with functional impairment in administrative data
Correlates of functional impairment in study sample
Effect of ADL impairment on postoperative mortality
Results
Identification of correlates of ADL impairment
Description of hip fracture study sample
Variable | Total N = 1,329 |
---|---|
Demographics
| |
Age
| |
Mean age, (SD) | 85.2 (6.9) |
66 – 75 years, N (%) | 117 (8.8) |
76 – 85 years, N (%) | 546 (41.1) |
> 85 years, N (%) | 666 (50.1) |
Female sex, N (%) | 968 (72.8) |
Long-term care resident, N (%) | 1043 (78.5) |
Medical comorbidity
| |
Charlson score, N (%) | |
0 | 103 (7.8) |
1 | 548 (41.2) |
2 | 288 (21.67) |
3+ | 390 (29.34) |
Number of major ADGs, N (%) | |
0 | 23 (1.73) |
1 | 140 (10.53) |
2 | 306 (23.02) |
3 | 344 (25.88) |
4 | 272 (20.47) |
5+ | 244 (18.36) |
Number of unique drugs, Mean (SD) | 12.27 (6.18) |
0 – 5 drugs, N (%) | 157 (11.81) |
6 – 10 drugs, N (%) | 389 (29.27) |
11 – 15 drugs, N (%) | 430 (32.36) |
>15 drugs, N (%) | 353 (26.56) |
Number of outpatient visits, Mean (SD) | 26.78 (19.78) |
≤ 10 visits, N (%) | 184 (13.84) |
11 – 20 visits, N (%) | 495 (37.25) |
> 20 visits, N (%) | 650 (48.91) |
Number of hospitalizations, Mean (SD) | 0.41 (0.75) |
Any hospital visit, N (%) | 396 (29.8) |
Number of ED visits, Mean (SD) | 1.34 (1.53) |
0 visits, N (%) | 463 (34.84) |
1 visit, N (%) | 393 (29.57) |
2 visits, N (%) | 250 (18.81) |
3 visits, N (%) | 223 (16.78) |
Medical conditions, N (%): | |
Congestive heart failure | 309 (23.25) |
Chronic obstructive lung disease | 386 (29.04) |
Dementia | 1057 (79.53) |
Depression | 804 (60.50) |
Diabetes | 357 (26.86) |
Hearing impairment | 137 (10.31) |
Ischemic heart disease | 540 (40.63) |
Malnutrition | 18 (1.35) |
Any ED visit for falls | 274 (20.6) |
Any hospitalization for falls | 24 (1.8) |
Obesity | 35 (2.63) |
Osteoarthritis | 577 (43.42) |
Osteoporosis | 260 (19.56) |
Parkinson’s disease | 74 (5.57) |
Pressure ulcer | 65 (4.89) |
Stroke | 340 (25.58) |
Urinary incontinence | 273 (20.54) |
Visual impairment | 34 (2.56) |
ADL Impairment
| |
Mean ADL score (SD) | 11.94 (7.66) |
Median ADL score (IQR) | 12 (5–18) |
Range | 0 - 28 |
ADL score category, N (%): | |
0 – 5 | 333 (25.06) |
6 – 10 | 268 (20.17) |
11 – 16 | 269 (20.24) |
16 – 20 | 248 (18.66) |
> 20 | 211 (15.88) |
Correlates of functional impairment in older adults with hip fractures
Variable | Parameter estimate | Standard error | Test statistic | P value | R2
|
---|---|---|---|---|---|
Demographics
| |||||
Age | |||||
Continuous | -0.0064 | 0.031 | 0.21 | 0.81 | 0.000 |
Categorical | F = 0.34 | 0.72 | 0.0005 | ||
66 – 75 | -- | -- | -- | -- | -- |
76 – 85 | 0.46 | 0.78 | 0.59 | 0.53 | |
> 85 years | 0.14 | 0.77 | 0.19 | 0.85 | |
Sex (Female vs Male) | 0.93 | 0.47 | 1.77 | 0.077 | 0.0023 |
LTC resident (Yes vs No) | 6.30 | 0.48 | 13.08 | <0.0001 | 0.11 |
Medical comorbidity
| |||||
Charlson score
| |||||
Total score | 0.078 | 0.11 | 0.70 | 0.48 | 0.0004 |
Categorical | F = 11.00 | <0.0001 | 0.032 | ||
0 | --- | --- | --- | --- | |
1 | 5.30 | 0.81 | 6.54 | <0.0001 | |
2 | 4.27 | 0.87 | 4.92 | <0.0001 | |
3 | 5.09 | 0.97 | 5.28 | <0.0001 | |
4+ | 4.45 | 0.89 | 5.00 | <0.0001 | |
Number of major ADGs
| |||||
Total number | 0.21 | 0.14 | 0.15 | 0.14 | 0.0016 |
F = 2.33 | 0.004 | 0.04 | |||
Categorical | |||||
0 | ---- | ---- | ---- | ---- | |
1 | 2.19 | 1.72 | 1.28 | 0.20 | |
2 | 3.09 | 1.65 | 1.87 | 0.06 | |
3 | 3.95 | 1.65 | 2.40 | 0.017 | |
4 | 3.83 | 1.66 | 2.31 | 0.021 | |
5+ | 2.97 | 1.59 | 1.78 | 0.75 | |
Number of outpatient visits in past year
| |||||
Total number | 0.041 | 0.011 | 3.91 | <0.0001 | 0.011 |
Categorical | F = 5.67 | 0.0085 | |||
≤ 10 visits | -- | -- | -- | 0.0035 | |
11 – 20 visits | 1.51 | 0.66 | 2.28 | -- | |
> 20 visits | 2.13 | 0.67 | 3.35 | 0.0227 | |
0.008 | |||||
Number of unique drugs
| |||||
Total number | -0.00016 | 0.034 | 0.00 | 0.99 | 0.000 |
Categorical | F = 1.63 | 0.18 | 0.0037 | ||
0 – 5 drugs | --- | --- | ---- | ---- | |
6 – 10 drugs | 1.25 | 0.72 | 1.72 | 0.085 | |
11 – 15 drugs | 1.29 | 0.71 | 1.80 | 0.072 | |
>15 drugs | 0.56 | 0.73 | 0.72 | 0.47 | |
Number of hospitalizations | |||||
Total number | -0.023 | 0.28 | -0.08 | 0.94 | 0.000 |
Any visit | 0.025 | 0.46 | 0.53 | 0.59 | 0.0002 |
Number of ED visits
| 0.017 | 0.14 | 0.12 | 0.90 | 0.000 |
Categorical | F = 0.91 | 0.43 | 0.002 | ||
0 visits | ---- | ----- | ---- | ---- | ---- |
1 visit | 0.57 | 0.53 | 1.08 | 0.28 | |
2 visits | -0.17 | 0.60 | -0.27 | 0.78 | |
>2 visits | 0.72 | 0.62 | 1.15 | 0.25 | |
Medical conditions
| |||||
CHF | -1.36 | 0.50 | -2.75 | 0.0061 | 0.0057 |
COPD | -1.41 | 0.46 | -3.07 | 0.0022 | 0.0071 |
Dementia | 4.56 | 0.51 | 9.00 | <0.0001 | 0.058 |
Depression | -0.43 | 0.43 | -1.00 | 0.32 | 0.0008 |
Diabetes | -0.30 | 0.47 | -0.65 | 0.52 | 0.0003 |
Hearing impairment | -1.15 | 0.69 | -2.19 | 0.029 | 0.0036 |
Ischemic heart disease | -1.03 | 0.43 | -2.40 | 0.016 | 0.0043 |
Malnutrition | 1.57 | 1.82 | 0.87 | 0.39 | 0.0006 |
Number of ED visit for falls | 0.99 | 0.34 | 2.95 | 0.0033 | 0.0065 |
Obesity | -0.24 | 1.31 | -0.18 | 0.86 | 0.0000 |
Osteoarthritis | -1.19 | 0.42 | -2.82 | 0.0049 | 0.0059 |
Parkinson’s disease | 2.51 | 0.91 | 2.75 | 0.0060 | 0.0057 |
Pressure ulcers | 2.03 | 0.97 | 2.08 | 0.037 | 0.0033 |
Stroke | 1.31 | 0.48 | 2.73 | 0.0064 | 0.0048 |
Urinary incontinence | -0.20 | 0.52 | -0.39 | 0.69 | 0.0001 |
Visual impairment | -2.27 | 1.33 | -1.71 | 0.088 | 0.0022 |
Variable | Parameter estimate | Standard error | Test statistic | P value | Adjusted R2
|
---|---|---|---|---|---|
Age
| --- | --- | --- | --- | -0.0010 |
Age, sex
| --- | --- | --- | --- | 0.0005 |
Age, sex, LTC
| --- | --- | --- | --- | 0.1161 |
Age, sex, LTC, Charlson
| --- | --- | --- | --- | 0.1259 |
Age, sex, LTC, Charlson, ADGs
| --- | --- | --- | --- | 0.1268 |
Age, sex, LTC, Charlson, ADGs, visits
| --- | --- | --- | --- | 0.1311 |
Age, sex, LTC, Charlson, ADGs, visits, medical conditions
| 0.1687 | ||||
Age
| |||||
66 – 75 years | 0.01957 | 0.72 | 0.03 | 0.98 | |
76 – 85 years | 0.24 | 0.42 | 0.57 | 0.57 | |
≥ 86 years | -- | -- | -- | -- | |
Sex
| 0.63 | 0.44 | 1.44 | 0.15 | |
LTC resident
| 5.18 | 0.51 | 10.22 | <0.0001 | |
Charlson comorbidity score
| -1.63 | 1.01 | -1.60 | 0.11 | |
0 | -0.37 | 0.63 | -0.59 | 0.56 | |
1 | -0.73 | 0.66 | -1.12 | 0.27 | |
2 | 0.76 | 0.74 | 1.02 | 0.31 | |
3 | --- | --- | --- | --- | |
≥ 4 | |||||
Number of major ADGs
| 1.00 | 1.65 | 0.61 | 0.54 | |
0 | 0.76 | 0.86 | 0.89 | 0.37 | |
1 | 1.03 | 0.69 | 1.50 | 0.13 | |
2 | 1.77 | 0.63 | 2.83 | 0.005 | |
3 | 0.96 | 0.63 | 1.52 | 0.13 | |
4 | --- | --- | --- | --- | |
≥ 5 | |||||
Total number of outpatient visits
| 0.03 | 0.01 | 3.51 | 0.005 | |
Medical conditions
| |||||
Congestive heart failure | -0.90 | 0.51 | -1.77 | 0.07 | |
Chronic obstructive lung | -1.50 | 0.44 | -3.38 | 0.0007 | |
Disease | |||||
Dementia | 2.09 | 0.63 | 3.51 | 0.001 | |
Hearing impairment | -1.07 | 0.64 | -1.68 | 0.09 | |
Ischemic heart disease | -0.60 | 0.43 | -1.38 | 0.17 | |
Osteoarthritis | -0.80 | 0.40 | -1.99 | 0.05 | |
Parkinson’s disease | 2.45 | 0.86 | 2.85 | 0.005 | |
Pressure ulcers | 1.86 | 0.90 | 2.06 | 0.04 | |
Stroke | 1.20 | 0.47 | 2.56 | 0.01 | |
Number of ER visits for falls | 0.68 | 0.31 | 2.17 | 0.03 |
Effects of ADL impairment, medical comorbidity, and medical conditions on postoperative mortality
ADL score | Died within 360 days | Alive at 360 days | Total |
---|---|---|---|
N (%) | N (%) | ||
0 – 5
| 86 (25.8) | 247 (74.2) | 333 |
6 – 10
| 94 (35.1) | 174 (64.9) | 268 |
11 – 15
| 111 (41.3) | 158 (58.7) | 269 |
16 – 20
| 104 (41.9) | 144 (58.1) | 248 |
> 20
| 92 (43.6) | 119 (56.4) | 211 |
Total
| 487 | 842 | 1329 |
Variable | Wald chi square | D.F | P value | C statistic | Max rescaled R2
|
---|---|---|---|---|---|
ADL scorea
| 26.46 | 4 | <0.0001 | 0.578 | 0.0282 |
ADL scoreb
| 21.79 | 1 | <0.0001 | 0.578 | 0.0226 |
Age | 9.42 | 2 | 0.008 | 0.544 | 0.01 |
Age, sex | 28.1 | 3 | <0.0001 | 0.580 | 0.03 |
Age, sex, LTC | 37.00 | 4 | <0.0001 | 0.597 | 0.04 |
Age, sex, LTC, Charlson | 53.45 | 8 | <0.0001 | 0.624 | 0.06 |
Age, sex, LTC, Charlson, ADGs | 60.69 | 13 | <0.0001 | 0.635 | 0.07 |
Age, sex, LTC, Charlson, ADGs, visits | 60.9 | 14 | <0.0001 | 0.634 | 0.07 |
Age, sex, LTC, Charlson, ADGs, visits, medical conditions | 81.03 | 24 | <0.0001 | 0.653 | 0.09 |
Age, sex, LTC, Charlson, ADGs, visits, medical conditions, ADL impairmenta
| 94.50 | 28 | <0.0001 | 0.668 | 0.11 |
Age, sex, LTC, Charlson, ADG, visits, medical conditions, ADL impairmentb
| 92.13 | 25 | <0.0001 | 0.67 | 0.10 |