[In-hospital clinical and pharmacological determinants of 120-day mortality and institutionalization after hip fracture: functional and pharmacological implications in Primary Care].
TL;DR
In post-discharge therapeutic adequacy, the analysis of osteoprotective therapy underscores the need for an individualized and coordinated clinical review, assuming that controlling frailty factors is a priority to prevent clinical failure and definitive institutionalization of older adults.
Abstract
Objective
To evaluate the in-hospital clinical and pharmacological factors predicting mortality and functional outcome at 120 days in an expanded cohort of older adults with hip fracture, analyzing the impact of de novo institutionalization and the role of longitudinal follow-up from Primary Care (PC). MATERIAL AND
Methods
A prospective, longitudinal, observational study was conducted on a cohort of 340 patients aged ≥ 75 years admitted for a hip fracture. Clinical (established delirium, GLIM malnutrition), pharmacological (vitamin D supplementation, antiresorptive treatment), functional, and social variables were evaluated. Follow-up at 30 and 120 days was conducted from Primary Care. Bivariate analysis and multivariate logistic regression were performed.
Results
The mean age was 88.3 years (73.8% women; n=251). The incidence of established delirium was 2.6% (n=9), and 52.9% (n=180) presented moderate/severe malnutrition. Pharmacologically, 2.6% (n=9) of patients were receiving prior antiresorptive treatment, compared to 31.8% (n=108) supplemented with vitamin D. Overall mortality at 120 days was 17.0% (n=55). Lethality was significantly higher in patients with delirium (66.7% vs. 15.6%; p<0.001) and malnutrition (26.1% vs. 6.2%; p<0.001). In bivariate analysis, baseline vitamin D supplementation was associated with lower medium-term mortality (9.5% vs. 20.5%; p=0.021); however, in the multivariate model, this effect lost independent significance (OR 0.51; 95% CI 0.24-1.10; p=0.085) compared to the weight of clinical comorbidities. A total of 41.5% (n=49) of previously autonomous community-dwelling survivors required de novo institutionalization.
Conclusions
In-hospital clinical complications determine medium-term vital decline. In post-discharge therapeutic adequacy, the analysis of osteoprotective therapy underscores the need for an individualized and coordinated clinical review, assuming that controlling frailty factors is a priority to prevent clinical failure and definitive institutionalization of older adults.