Examining Heterogeneity of Functional Recovery Among Older Adults With Hip Fractures
published online 18 January 2010.
Objective
To examine heterogeneity in 1-year functional recovery following postacute rehabilitation among older adults with hip fracture.
Methods
Two hundred twenty-five community-dwelling older adults with hip fracture who received postacute rehabilitation in 5 rehabilitation facilities in Baltimore, Maryland, were recruited during postacute rehabilitation (baseline) and follow-up at 2, 6, and 12 months following postacute rehabilitation discharge. Functional recovery was measured by the activities of daily living (ADL) and instrumental activities of daily living (IADL) scores. A mixed-effect model was used to examine factors associated with postacute rehabilitation functional recovery; fixed and random effects estimates from the models were used to demonstrate heterogeneity in functional recovery.
Results
Results indicated that there was an overall trend in both ADL and IADL functional improvement at 2 months following postacute rehabilitation, with continued improvement to 6 months, after which functional recovery slowed down and remained constant through the year. Individuals whose functional recovery did not conform to these patterns were identified and their functional recovery that deviated substantially from the group mean was demonstrated.
Conclusions
Functional recovery patterns in elderly hip fracture patients are heterogeneous. To foster functional independence, health care professionals should consider individual recovery trajectories using a modeling approach appropriate for longitudinal or repeated measurement data such as a linear mixed-effects model when designing individualized rehabilitation and postacute rehabilitation care plans.
aState University of New York (SUNY) at Albany, School of Public Health, Rensselaer, NY
bState University of New York (SUNY) at Albany, School of Public Health, Department of Epidemiology and Biostatistics, Rensselaer, NY
cState University of New York (SUNY) at Albany, School of Education, Albany, NY
dStatistical and Experimental Design Section, Research Resources Branch, Biomedical Research Center, National Institute on Aging, National Institutes of Health, Baltimore, MD
Address correspondence to Yuchi Young, DrPH, State University of New York (SUNY) at Albany, School of Public Health, 1 University Place, Room 171, Rensselaer, NY 12144.
ABSTRACT