Association between Caregiver Role and Short- and Long-Term Functional Recovery after Hip Fracture: A Prospective Study

作者：Nardi Marlis; Fischer Karina; Dawson Hughes Bess; Orav Endel J; Meyer Otto W; Meyer Ursina; Beck Sacha; Simmen Hans Peter; Pape Hans Christoph; Egli Andreas; Willett Walter C; Theiler Robert; Bischoff Ferrari Heike A^*

来源：Journal of the American Medical Directors Association, 2018, 19(2): 122-129.

DOI：10.1016/j.jamda.2017.08.009

• Hip fracture
• functional recovery
• caregiver role
• timed up and go test
• outcome

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.

• 出版日期2018-2