Does Frailty Predict Functional Recovery 3 Months from Hip Fracture in Elderly Patients?

Introduction: Hip fracture remains a devastating condition within the elderly population with only 39% of patients return to their pre injury functional level. Frailty reflects a clinical entity associated with mortality following hip fracture. The Patient-Reported Outcomes Measurement Information System (PROMIS) score has become a leading functional outcome measure and no study has yet examined difference in those outcomes in frail and non frail population. We sought to evaluate these two measures in predicting functional recovery 3 months from hip fracture.

Methods: We prospectively enrolled patients admitted to a tertiary medical center from January 2016-January 2017 who underwent surgical repair of a low-trauma hip fracture. Fried frailty index was calculated upon admission. PROMIS-29 was collected upon admission and re-administered 3 months post-operatively.

Results: 29 patients (10 non frail; 15 pre frail and 4 frail) completed 3 months follow up. Mean age was 80 years and 69% were female. PROMIS scores at base line were significantly worse in the frail patients versus non-frail: fatigue 63.0 vs 35.5 and physical function 33.5 vs 56, accordingly (all p values <0.0034). Patients physical function score at 3 months was 34.2 vs 44.7 (p=0.3) and change in physical function at 3 months was -0.5 vs -11.2 (p=0.4) between frail and non-frail patients accordingly. At 3 months post hip fracture, non frail patients lost 20% of their baseline physical function while pre frail patients lost 16% and frail patients 1%.

Discussion: Frailty may not be a reliable predictor for functional outcome 3 months following hip fracture. Frail patients are extremely deconditioned at baseline that functional loss and recovery may be minor at this time point. At three months post hip fracture most patients were far from complete recovery thus necessitating longer follow up. Prospective studies conducting rehabilitative interventions to decrease recovery time are necessary.