Background/Purpose: Hip fractures are a serious public health issue with a significant population burden, especially among those over 65 years old. Social isolation—how integrated a patient is into his/her community—is a novel and potentially modifiable risk factor for poor health outcomes after low trauma hip fracture. This study evaluates the association of pre-operative social isolation with death, short-term complications and patient-reported functional recovery in elderly patients 3 months following surgical repair of low-trauma hip fracture.

Methods: The Lubben Social Networks Scale-18 (LSNS-18), a validated instrument specifically designed to measure social isolation in the elderly, PROMIS-29, which measures patient-reported outcomes, and the Lower Extremity Activity Scale (LEAS), which measures physical function, were administered to cognitively intact patients ≥ 65 years old with no active cancer, 2-4 days after surgical repair of hip fracture. Patients were specifically asked about their pre-fracture status. Patients were contacted 1 and 3 months after surgery and asked about adverse events and hospitalizations. The LSNS-18, PROMIS-29 and the LEAS were administered again at 3 months.

Results: 109 patients were enrolled, 72.5% female, 92.7% white, 78% college educated with a mean age of 80.7± 8.5 years. 45% of patients enrolled were socially isolated. Of the 109 patients enrolled, 19 had adverse events including pulmonary emboli, hypotension, hypoxia, urinary tract infection, peri-prosthetic fracture, CHF exacerbation, cholecystitis, lower extremity cellulitis, falls, wound dehiscence and duodenal ulcers. 5 patients died within the first 3 months. Of the 76 patients eligible for 3 month follow-up, 63 (83%) completed 3-month questionnaires. A higher proportion of socially isolated patients died by 3 months (8.2% vs. 1.7%), although this was not statistically significant (p=0.172). There was no statistically significant difference between socially isolated and non-socially isolated patients in short-term complications, or PROMIS-29 and LEAS scores 3 months after surgery.

Conclusion: There is a positive trend suggesting social isolation is associated with 3-month mortality in elderly patients undergoing surgical repair of low trauma hip fracture. There was no association between social isolation and short-term complications or self-reported short-term functional recovery. Whether social isolation is associated with longer term functional outcomes or mortality is unknown. Recruitment for this study is ongoing and all subjects will be studied for up to 1 year following surgery.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-after-hip-fracture-in-the-elderly-does-social-isolation-matter/