Factors associated with frailty and the effect of frailty on postoperative outcomes in older adults with hip fracture

Abstract

BACKGROUND: The incidence of hip fractures is also increasing rapidly with the aging population and is currently considered a major significant global health issue due to its high mortality rate. The aim of this research is to investigate the relationship between prefracture frailty and postoperative patient outcomes and identify factors associated with frailty in older adults operated for hip fracture. METHODS: Descriptive, cross-sectional study. Patients aged 65 and older who underwent surgery for hip fracture were included. Data were collected in face-to-face interviews with patients in their rooms preoperatively and on the first postoperative day. The study was approved by the non-interventional research ethics committee of Dokuz Eylul University. Data analysis was performed using descriptive statistics, independent samples t-test, One Way ANOVA, correlation, and multiple linear regression analyses. RESULTS: Of the 128 patients included in the study (mean age 78.45±8.36 years), 46.1% (n=59) were prefrail, and 39.8% (n=51) were frail. Higher frailty scores were associated with female sex, chronic disease, use of multiple long-term medications, being immobile or requiring mobility assistive devices prior to the fracture, recent decrease in appetite, need for postoperative intensive care, postoperative complications, postoperative pressure injury development, and mortality within the first month of discharge (p<0.05). Preoperative frailty score was positively correlated with number of chronic diseases, preoperative fear of falling, nutritional risk score, comorbidity index score, and length of hospital stay and negatively correlated with preoperative and postoperative Katz ADL score and postoperative creatinine concentration(p<0.05). The mean Frailty Scale score was 2.16±1.26; pre-fracture nutritional status (β=0.312, p<0.001) and functional independence status (β=0.216, p=0.012) were significant predictors of frailty. CONCLUSION: This study showed that frailty was prevalent among older adults undergoing hip fracture surgery and had a significant impact on postoperative patient outcomes. Pre-fracture nutritional and functional status were significant factors associated with frailty. Preoperative frailty assessment of patients presenting with hip fractures, especially focusing on nutritional and functional status, may contribute to better management of treatment and care.