Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients

Wantonoro Wantonoro; Yea-Ing Lotus Shyu; Mei-Ling Chen; Hsiu-Hsin Tsai; Min-Chi Chen; Chi-Chuan Wu

doi:10.1097/JNR.0000000000000463

Functional Status in Older Persons After Hip Fracture Surgery: A Longitudinal Study of Indonesian Patients

J Nurs Res. 2022 Apr 22;30(3):e211. doi: 10.1097/JNR.0000000000000463. Online ahead of print.

Authors

Wantonoro Wantonoro¹, Yea-Ing Lotus Shyu², Mei-Ling Chen³, Hsiu-Hsin Tsai³, Min-Chi Chen⁴, Chi-Chuan Wu⁵

Affiliations

¹ PhD, CNS, RN, Lecturer, Faculty of Health Science, Department of Nursing, Universitas 'Aisyiyah, Yogyakarta, Indonesia.
² PhD, RN, FAAN, Distinguished Professor, School of Nursing, College of Medicine, and Healthy Aging Research Center, Chang Gung University; Research Fellow, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital; and Adjunct Professor, Department of Gerontology and Health Care Management, Chang Gung University of Science and Technology, Taiwan, ROC.
³ PhD, RN, Professor, School of Nursing, College of Medicine, Chang Gung University, Taiwan, ROC.
⁴ PhD, Professor, Department of Public Health & Biostatistics Consulting Center, Chang Gung University, Taiwan, ROC.
⁵ MD, Professor and Attending Physician, Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taiwan, ROC.

PMID: 34690333
DOI: 10.1097/JNR.0000000000000463

Abstract

Background: Hip fractures are one of the most serious injuries affecting older adults. Evidence-based knowledge regarding the functional status of older persons after hip fracture can provide information critical for developing effective continuous-care and rehabilitation programs.

Purpose: This study was developed to examine the post-hospital-discharge outcome measures and predictors of functional status in older adults in Indonesia after hip fracture surgery.

Methods: The functional status of 109 patients discharged from an orthopedic hospital in Indonesia after hip fracture surgery was evaluated in this prospective cohort study. Functional status was evaluated using measures of physical and independent activities of daily living (PADL and IADL, respectively) at 1, 3, and 6 months postdischarge. Predictors of changes in functional status, including age, length of hospital stay, comorbidity, prefracture walking ability, type of surgery, status of depression and nutrition, type of insurance, and residential status (urban vs. rural), were also examined. Data were analyzed using generalized estimating equations.

Results: Significant improvements in PADL were found at 3 and 6 months, and significant improvements in IADL were found at 6 months. Predictors of poor outcomes found in this study included age, a dependent prefracture walking ability, depression, and having public health insurance.

Conclusions/implications for practice: The findings of this study support the effectiveness of using presurgery assessments to identify individuals at a higher postdischarge risk of having poor PADL and IADL outcomes. Home nursing or subacute rehabilitation is recommended to improve and maintain functional status in older persons after hip fracture surgery. In addition, interventions and rehabilitation should take into consideration different recovery periods for PADL and IADL after hospital discharge after hip fracture surgery.