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
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Article info
Publication history
Published online: January 06, 2010
Footnotes
This study was supported by a grant from the National Institutes of Health (supported by NIA grant 1 R03 AG 17821 and National Institute on Aging (NIA) contract NO-1-AG-2112).
Identification
Copyright
© 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.
