The impact of hip fracture (HF) on the functional status (FS) of older persons in Rio de Janeiro, Brazil: results of a prospective cohort study.

There is no prospective study investigating the impact of hip fracture (HF) on functional status (FS) in Brazil. The objective of this study was to investigate the impact of a HF on the FS of older persons 1 year after the fracture and the factors associated with decline in FS 1 year after the fracture. Two hundred and forty-six patients who were admitted to one of four hospitals after HF participated. The sample for this study consisted of 160 patients who were still alive and had information on functional limitations after 1 year. The Brazil Old Age Schedule (BOAS) was used to assess FS before and 1 year after HF. Logistic regression analyses were used to identify predictors of decline 1 year after fracture. Of the patients, 46.3% did not achieve their prior FS. Older age, being underweight, total length of stay and the use of psychotics/sedatives and anxiolitics were associated in multivariate analyses with decline in FS. Working before the fracture was protective of decline in FS. We conclude that HF severely compromised the FS of older persons in Rio de Janeiro, Brazil.

The impact of prefracture and hip fracture characteristics on mortality in older persons in Brazil.

BACKGROUND: Hip fractures in the elderly are common and associated with considerable mortality and disability. Although well known in industrialized countries, the factors associated with mortality after hip fractures are not reported frequently in developing countries and little is known regarding risk factors in Latin America. QUESTIONS/PURPOSE: We investigated the rate of 1-year mortality and prefracture and fracture characteristics associated with mortality after a hip fracture in elderly Brazilian patients in a large metropolitan area. METHODS: Two hundred forty-six persons 60 years and older admitted to four hospitals in Rio de Janeiro were included after experiencing fractures and were followed for 1 year. Data were collected on sociodemographic, health, and functional status; type of surgery; length of stay; and complications after surgery. Cox regression analyses were conducted to investigate factors associated with 1-year mortality after hip fracture. RESULTS: Of the 246 patients, 86 died (35%). Of those 86, 22 died in the hospital (25.6%) and 64 (74.4%) died after discharge. Functional status before fracture, older age, male gender, and higher surgical risk increased the risk of mortality, whereas the use of antibiotics and the use of physical therapy after surgery decreased the risk. CONCLUSIONS: Our mortality rate was higher than those reported from industrialized countries. The use of antibiotics and physical therapy are potentially modifiable factors to improve patients' survival after fracture in Brazil. LEVEL OF EVIDENCE: Level II, prognostic study. See the Guidelines for Authors for a complete description of the levels of evidence.