![]() We used a prospective cohort of patients with hip fracture to examine (1) how the duration of immobility affects functional outcomes, (2) how the duration of immobility affects mortality, and (3) how specific, potentially modifiable care processes affect the total duration of immobility.Ĭonsecutive admissions to 4 hospitals were screened for cases of hip fracture for a 12-month period in 1997-1998. These patients experience immobility from delay awaiting surgery pain surgery, anesthesia, and their postoperative effects complications and treatments that impede mobilization. In the present study, we examined the effects of immobility in older hospitalized patients following hip fracture. There have been recent reports that self-reported bed rest is associated with declines in function in community-dwelling older persons, 5, 6 but few studies 7 have examined the relationship between inpatient bed rest and health outcomes. 1 - 4 However, some of these effects have been extrapolated from studies of other populations (eg, healthy volunteers), and effects have typically been shown for intermediate outcomes (eg, muscle strength). Hospitalization and bed rest have been shown to have deleterious effects on muscle, volume status, respiratory function, urinary tract, and skin integrity. Getting the hospitalized older patient out of bed is frequently part of the treatment plan but is often just one of many priorities for the hospital staff. The adverse association of immobility was strongest in patients using personal assistance or supervision with locomotion at baseline (difference in 6-month mortality between the 90th and 10th percentile of immobility was −17.1% for this group and only 1.2% for patients independent in locomotion at baseline).Ĭonclusion In patients with hip fracture, delay in getting the patient out of bed is associated with poor function at 2 months and worsened 6-month survival. Compared with patients with a longer duration of immobility (ie, at the 90th percentile) in adjusted analyses, patients at the 10th percentile of immobility had lower 6-month mortality (−5.4% 95% confidence interval, −10.9% to −1.0%) and better Functional Independence Measure score for locomotion (0.99 points 95% CI, 0.3 to 1.7 points, with higher values indicating better function), but there was no significant difference in locomotion by 6 months (0.58 points 95% CI, −0.3 to 1.4 points). Results Patients with hip fracture experienced an average of 5.2 days of immobility. Follow-up was obtained on function (using the Functional Independence Measure) at 2 and 6 months and on survival at 6 months. “Days of immobility” was defined as days until the patient moved out of bed beyond a chair. We collected information from hospital visits, medical records, and interviews. ![]() Methods We conducted a prospective cohort study of 532 patients 50 years and older, who were treated with surgery after hip fracture in 4 hospitals in New York. We examined how immobility is associated with function and mortality in patients with hip fracture.
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