Declining daily functioning as a prelude to a hip fracture in older persons—an individual patient data meta-analysis

• Published in: Age and ageing Vol. 51; no. 1
• Main Authors: Ravensbergen, Willeke M, Blom, Jeanet W, Kingston, Andrew, Robinson, Louise, Kerse, Ngaire, Teh, Ruth O, Groenwold, Rolf H H, Gussekloo, Jacobijn
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 06.01.2022; Oxford Publishing Limited (England)
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Fractured hips; Fractures; Hip; Hip Fractures - diagnosis; Hip Fractures - epidemiology; Humans; Longitudinal Studies; Meta-analysis; Netherlands - epidemiology; New Zealand - epidemiology; Older people; Research Paper; Standard deviation; Very old; New Zealand; Netherlands; older people; disability; hip fracture; function
• ISSN: 0002-0729; 1468-2834; 1468-2834
• DOI: 10.1093/ageing/afab253

Abstract Background Daily functioning is known to decline after a hip fracture, but studies of self-reported functioning before the fracture suggest this decline begins before the fracture. Objective Determine whether change in functioning in the year before a hip fracture in very old (80+) differs from change in those without a hip fracture. Design Two-stage individual patient data meta-analysis including data from the Towards Understanding Longitudinal International older People Studies (TULIPS)-consortium. Setting Four population-based longitudinal cohorts from the Netherlands, New Zealand and the UK. Subjects Participants aged 80+ years. Methods Participants were followed for 5 years, during which (instrumental) activities of daily living [(I)ADL] scores and incident hip fractures were registered at regular intervals. Z-scores of the last (I)ADL score and the change in (I)ADL in the year before a hip fracture were compared to the scores of controls, adjusted for age and sex. Results Of the 2,357 participants at baseline, the 161 who sustained a hip fracture during follow-up had a worse (I)ADL score before the fracture (0.40 standard deviations, 95% CI 0.19 to 0.61, P = 0.0002) and a larger decline in (I)ADL in the year before fracture (−0.11 standard deviations, 95% CI −0.22 to 0.004, P = 0.06) compared to those who did not sustain a hip fracture. Conclusions In the very old a decline in daily functioning already starts before a hip fracture. Therefore, a hip fracture is a sign of ongoing decline and what full recovery is should be seen in light of the pre-fracture decline.