Outcome in ambulatory status immediately following hip fracture surgery in the acute setting: A comparison of nursing home residents and community older adults

Objective: To compare the ambulatory status following hip fracture surgery in the acute setting between older adults from long-term care facilities (LTCF) and the community. Setting: A 650-bed, urban, inner city, university-affiliated teaching hospital. Methods: One hundred forty hip fracture patients (60-97 years) from long-term care facilities and the community were examined. Ambulatory status before and after surgery was categorized four ways based on the degree of independence in ambulation: A1 = independent ambulation (with or without an assisting device), A2 = assistance of another person required, A3 = predominant use of a wheelchair, and A4 = bed-bound. Change in ambulatory status was designated as "moderate" if the deterioration was one status level only (A1 to A2, A2 to A3, and A3 to A4) or "major" if the deterioration was more than one status level (A1 to A3/A4 or A2 to A4). Additional variables such as age, sex, risk factors, length of stay, history of drug use, and laboratory results also were examined. Results: Hip fracture patients from LTCF were older (P = 0.0160) and had more overall risk factors for hip fracture (P = 0.0039) than community patients. They also had higher rates of dementia (P < 0.000), arrhythmia (P = 0.025), delirium (P = 0.0016) and anxiolytics use (P = 0.019) than patients from the community. On admission, LTCF patients had lower serum calcium (P = 0.0003), phosphorus (P = 0.0210), and albumin (P = 0.0004) than community patients. Before hospitalization they also were less ambulatory (P = 0.002) than community patients. Post surgery, ambulatory status declined in both groups. However, a "major" change (decline) in ambulatory status occurred more often in LTCF patients (P = 0.001). Conclusions: A greater decline in ambulatory status is seen in patients from LTCF than in community patients, immediately following hip fracture surgery. Compared with community patients, LTCF patients are also older, sicker (higher total risk score) and have an increased risk for a decline in functional status.