Hip Fractures Among Elderly Women: Longitudinal Comparison of Physiological Function Changes and Health Care Utilization

Objective

To compare physiological and functional impairments and their impact on health care use patterns among disabled older women with and without hip fracture.

Methods

Data from the 3-year longitudinal Women's Health and Aging Study I (WHAS-I) and Medicare Current Beneficiaries Survey (MCBS) were used for this comparison study. Outcome variables include physiological measures (eg, hip and knee strength, functional reach), functional impairments (ADLs, IADLs), and health care use (physician visits). Generalized Estimation Equation (GEE) models were used to examine the differences between groups on physiological and functional change and health service use over time.

Results

Three-year crude mortality rates were significantly higher in the hip fracture group (25%) than in the comparison group (18%); however, statistical significance did not persist after adjusting for age, race, education, living arrangement, depression, and comorbidity (RR = 1.5; P = .17). All physiological and functional measures deteriorated over time, regardless of presence or absence of hip fractures. After adjusting for covariates, the fracture group was significantly worse in knee strength (β = –0.91; P = .01), usual walking speed (β = –0.04; P = .01) and rapid walking speed (β = –0.05; P = .02), and worse IADL function (β = 0.26; P = .002) than the non–hip fracture group. The rate of additional impairment for both hip fracture group and non–hip fracture group was 0.013 IADL units per month (P = .001). However, there were no significant differences in health care use between the groups.

Conclusion

In spite of worse physiological and IADL impairments, once the women recovered from hip fracture surgery, they did not necessarily use more health care resources than non–hip fracture patients. To prevent functional deterioration, interventions need to focus on knee strength and mobility training.

Keywords: Mortality, impairment, hip fracture, aged, health care use