Abstract
Objectives
After a hip fracture, 50% of senior patients are left with permanent functional decline
and 30% lose their autonomy. The aim of this prospective study was to evaluate whether
seniors who are in a caregiver role have better functional recovery after hip fracture
compared with noncaregivers.
Design
Prospective observational study.
Setting
A total of 107 Swiss patients with acute hip fracture age 65 years and older (84%
women; 83.0 ± 6.9 years; 87% community-dwelling).
Measurements
At baseline, participants were asked if they were caregivers for a person, a pet,
or a plant. Lower-extremity mobility was measured using the Timed Up and Go (TUG)
test at baseline during acute care (day 1–12 after hip fracture surgery) and at 6
and 12 months follow-up. Subjective physical functioning (SPF) was rated for prefracture
values and at 6 and 12 months follow-up using the Short Form 36 Health Survey questionnaire.
Differences in TUG performance or SPF between caregivers and noncaregivers at 6 and
12 months were assessed using multivariable repeated-measures analysis adjusted for
age, sex, body mass index, Charlson comorbidity index, Mini-Mental State Examination,
living condition, baseline TUG, and treatment (vitamin D, home exercise program as
part of the original trial).
Results
At baseline, adjusted TUG performance was better in caregivers of any kind compared
with noncaregivers (40.9 vs 84.4 seconds, P < .0001). At 6 months, and after adjustment for baseline TUG performance and other
covariates, TUG was better in caregivers of any kind (−6.4 seconds, P = .007) and caregivers of plants (−6.6 seconds, P = .003) compared with noncaregivers. At 12 months, only caregivers of persons had
better TUG performance compared with noncaregivers (−7.3 seconds, P = .009). Moreover, at 12 months, SPF was better in caregivers of persons (58.9 vs
45.6, P = .01) and caregivers of any kind (50.8 vs 39.3, P = .02) compared with noncaregivers.
Conclusions
Senior hip fracture patients who have a caregiver role of any kind, and especially
of plants, had better short-term recovery after hip fracture assessed with the TUG.
For long-term recovery, senior hip fracture patients who are caregivers for other
persons appeared to have a significant benefit. These benefits were independent of
baseline function and all other covariates.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology and outcomes of osteoporotic fractures.Lancet. 2002; 359: 1761-1767
- A systematic review of hip fracture incidence and probability of fracture worldwide.Osteoporosis Int. 2012; 23: 2239-2256
- Predictors of hospital readmission in a cohort of 236 elderly discharged after surgical repair of hip fracture: One-year follow-up.Aging Clin Exp Res. 2008; 20: 253-259
- Recovery from hip fracture in eight areas of function.J Gerontol A Biol Sci Med Sci. 2000; 55: M498-M507
- Epidemiology of osteoporosis and osteoporotic fractures.Epidemiol Rev. 1985; 7: 178-208
- Hospital readmissions after hospital discharge for hip fracture: Surgical and nonsurgical causes and effect on outcomes.J Am Geriatr Soc. 2003; 51: 399-403
- Orthogeriatric care models and outcomes in hip fracture patients: A systematic review and meta-analysis.J Orthop Trauma. 2014; 28: e49-e55
- Effect of high-dosage cholecalciferol and extended physiotherapy on complications after hip fracture: A randomized controlled trial.Arch Intern Med. 2010; 170: 813-820
- A pooled analysis of vitamin D dose requirements for fracture prevention.N Engl J Med. 2012; 367: 40-49
- Extended exercise rehabilitation after hip fracture improves patients' physical function: A systematic review and meta-analysis.Phys Ther. 2012; 92: 1437-1451
- Protein supplements increase serum insulin-like growth factor-I levels and attenuate proximal femur bone loss in patients with recent hip fracture. A randomized, double-blind, placebo-controlled trial.Ann Intern Med. 1998; 128: 801-809
- Zoledronic acid in reducing clinical fracture and mortality after hip fracture.N Engl J Med. 2007; 357: nihpa40967
- Zoledronic acid results in better health-related quality of life following hip fracture: The HORIZON-Recurrent Fracture Trial.Osteoporos Int. 2011; 22: 2539-2549
- Predictors of functional recovery one year following hospital discharge for hip fracture: A prospective study.J Gerontol. 1990; 45: M101-M107
- Hip fracture.Clin Geriatr Med. 1994; 10: 589-609
- Is caregiving hazardous to one's physical health? A meta-analysis.Psychol Bull. 2003; 129: 946-972
- Caregiver burden: A clinical review.JAMA. 2014; 311: 1052-1060
- Predictors of caregiver burden in caregivers of individuals with dementia.J Adv Nurs. 2012; 68: 846-855
- Caregiving as a risk factor for mortality: The caregiver health effects study.JAMA. 1999; 282: 2215-2219
- The effects of choice and enhanced personal responsibility for the aged: A field experiment in an institutional setting.J Pers Soc Psychol. 1976; 34: 191-198
- Long-term effects of a control-relevant intervention with the institutionalized aged.J Pers Soc Psychol. 1977; 35: 897-902
- Perceived control in the lives of older adults: The influence of Langer and Rodin's work on gerontological theory, policy, and practice.The Gerontologist. 2014; 54: 67-74
- Balance in elderly patients: The “get-up and go” test.Arch Phys Med Rehabil. 1986; 67: 387-389
- The timed “Up & Go”: A test of basic functional mobility for frail elderly persons.J Am Geriatr Soc. 1991; 39: 142-148
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- Measures of adult general functional status: SF-36 Physical Functioning Subscale (PF-10), Health Assessment Questionnaire (HAQ), Modified Health Assessment Questionnaire (MHAQ), Katz Index of Independence in activities of daily living, Functional Independence Measure (FIM), and Osteoarthritis-Function-Computer Adaptive Test (OA-Function-CAT).Arthritis Care Res (Hoboken). 2011; 63: S297-S307
- SF-36 health survey update.Spine (Phila Pa 1976). 2000; 25: 3130-3139
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- “Mini-Mental State.” A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Performance-based or self-report measures of physical function: Which should be used in clinical trials of hip fracture patients?.Arch Phys Med Rehabil. 2008; 89: 2146-2155
- Measures of physical functioning after hip fracture: Construct validity and responsiveness of performance-based and self-reported measures.Age Ageing. 2012; 41: 659-664
- Gardening for the disabled.Nurs Times. 1973; 69: 678-680
- Gardening in rehabilitation.Physiotherapy. 1973; 59: 80-83
- Gardening as a rehabilitation adjunct.J Rehabil. 1983; 49: 39-41
- Horticultural therapy: The 'healing garden'and gardening in rehabilitation measures at Danderyd Hospital Rehabilitation Clinic, Sweden.Pediatr Rehabil. 2004; 7: 245-260
- Increasing engagement in a home for the elderly by providing an indoor gardening activity.Behav Res Ther. 1979; 17: 127-135
- Therapeutic effects of an indoor gardening programme for older people living in nursing homes.J Clin Nurs. 2010; 19: 949-958
- Benefits of sensory garden and horticultural activities in dementia care: A modified scoping review.J Clin Nurs. 2014; 23: 2698-2715
- Physiological relaxation induced by horticultural activity: Transplanting work using flowering plants.J Physiol Anthropol. 2013; 32: 15
- Interaction with indoor plants may reduce psychological and physiological stress by suppressing autonomic nervous system activity in young adults: A randomized crossover study.J Physiol Anthropol. 2015; 34: 21
- One-year outcomes in caregivers of critically ill patients.N Engl J Med. 2016; 374: 1831-1841
- The therapeutic value of pets.West J Med. 1986; 144: 103-105
- Pet ownership may be a factor in improved health of the elderly.J Nutr Elder. 1996; 15: 15-31
- Influence of companion animals on the physical and psychological health of older people: An analysis of a one-year longitudinal study.J Am Geriatr Soc. 1999; 47: 323-329
- Regular dog-walking improves physical capacity in elderly patients after myocardial infarction.Coll Antropol. 2011; 35: 73-75
- Pet ownership, social support, and one-year survival after acute myocardial infarction in the Cardiac Arrhythmia Suppression Trial (CAST).Am J Cardiol. 1995; 76: 1213-1217
- The benefit of pets and animal-assisted therapy to the health of older individuals.Curr Gerontol Geriatr Res. 2014; 2014: 623203
- Pet ownership and cardiovascular risk reduction: Supporting evidence, conflicting data and underlying mechanisms.Clin Exp Pharmacol Physiol. 2011; 38: 734-738
- Can therapy dogs improve pain and satisfaction after total joint arthroplasty? A randomized controlled trial.Clin Orthop Relat Res. 2015; 473: 372-379
Article info
Publication history
Published online: September 30, 2017
Footnotes
This project was supported by the Swiss National Foundations (NFP-53), a Swiss National Foundation Professorship (Swiss National Foundations Professorship Grant PP00B-114864) and the Baugarten Foundation Centre Grant. All funding sources were independent and had no influence on the study design, the collection, analyses, and interpretation of our data, writing of this report or in the decision to submit the paper for publication. The Swiss National Foundations (NFP-53) monitored the original trial in several site visits.
Clinical Trials Registry (original trial): NCT00133640.
The authors declare no conflicts of interest.
Identification
Copyright
© 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
