Baseline and 1-year follow-up differences between hip-fracture patients admitted from nursing homes and the community. A cohort study on 509 consecutive patients (FONDA Cohort).

OBJECTIVE: To determine the clinical and functional differences at hospital admission and at 1 year after a hip fracture (HF) in nursing homes (NH) and community-dwelling (CD) patients. METHODS: All patients with HF admitted to the orthogeriatric unit at a university hospital between January 2013 and February 2014 were prospectively included. Clinical and functional variables, and mortality were recorded during the hospital admission. The patients were contacted by telephone at 1 year to determine their vital condition and functional status. RESULTS: A total of 509 patients were included, 116 (22.8%) of whom came from NH. Compared with the CD patients, the NH patients had higher surgical risk (ASA ≥3: 83.6% vs. 66.4%, P<.001), poorer theoretical vital prognosis (Nottingham Profile ≥5: 98.3% vs. 56.6%, P<.001), higher rate of previous functional status (median Barthel index: 55 [IQR, 36-80] vs. 90 [IQR, 75-100], P<.001), poorer mental status (Pfeiffer's SPMSQ>2: 74.1% vs. 40.2%, P<.001), and a higher rate of sarcopenia (24.3% vs. 15.2%, P<.05). There were no differences in in-hospital or at 1-year mortality. At 1 year, NH patients recovered their previous walking capacity at a lower rate (38.5% vs. 56.2%, P<.001). CONCLUSIONS: Among the patients with HF treated in an orthogeriatric unit, NH patients had higher, surgical risk, functional and mental impairment, and a higher rate of sarcopenia than CD patients. At 1 year of follow-up, NH patients did not have higher mortality, but they recovered their previous capacity for walking less frequently.

Prevalence of malnutrition in a cohort of 509 patients with acute hip fracture: the importance of a comprehensive assessment.

Backgrounds/objectives:Malnutrition is very common in acute hip fracture (HF) patients. Studies differ widely in their findings, with reported prevalences between 31 and 88% mainly because of small sample sizes and the use of different criteria. The aim of this study was to learn the prevalence of malnutrition in a large cohort of HF patients in an comprehensive way that includes the frequency of protein-energy malnutrition, vitamin D deficiency and sarcopenia. SUBJECTS/METHODS: A 1-year consecutive sample of patients admitted with fragility HF in a 1300-bed public University Hospital, who were assessed within the first 72 h of admission. Clinical, functional, cognitive and laboratory variables were included. Energy malnutrition (body mass index (BMI) <22 kg/m2), protein malnutrition (serum total protein <6.5 g/dl or albumin <3.5 g/dl), vitamin D deficiency (serum 25-OH-vitamin D <30 ng/dl) and sarcopenia (low muscle mass plus low grip strength) were considered. RESULTS: Five hundred nine HF patients were included. The mean age was 85.6±6.9 years and 79.2% were women. Ninety-nine (20.1%) patients had a BMI <22 kg/m2. Four hundred nine patients (81.2%) had protein malnutrition. Eighty-seven (17.1%) patients had both energy and protein malnutrition. Serum vitamin D was <30 ng/ml in 466 (93%) patients. The prevalence of sarcopenia was 17.1%. CONCLUSIONS: Protein malnutrition and vitamin D deficiency are the rule in acute HF patients. Energy malnutrition and sarcopenia are also common. A nutritional assessment in these patients should include these aspects together.