Background/Purpose:

Hip fractures are a serious public health issue with a significant population burden, especially among those over age 65. Social isolation—how integrated a patient is in their community—is a novel and potentially modifiable risk factor for poor health outcomes after low energy hip fracture. This study evaluates the association of pre-operative social isolation with death, adverse events, and patient-reported outcomes in elderly patients 1 year after surgical repair of low energy 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 a variety of important patient-reported domains; and the Lower Extremity Activity Scale (LEAS), which measures physical function, were administered to cognitively intact patients ≥ age 65 with no active cancer, 2-4 days after surgical repair of hip fracture. Patients were specifically instructed to answer based on their pre-fracture status. Patients were contacted at 4 weeks, 3 months, and 1 year after surgery. The LSNS-18, PROMIS-29, and LEAS were re-administered at 1 year. Data were analyzed using t-tests, chi-square tests, Wilcoxon rank-sum tests and Spearman correlations.

Results:

203 patients enrolled: 71.9% female, 91.6% white, 78.7% college educated, with a median age of 81.8 [74.1, 87.3] years. 36% were socially isolated. Of the 9 known deaths within 1 year, 6/9 (67%) were socially isolated, a much higher percentage than the overall cohort, though not statistically significant (p=0.095).

73/99 (74%) of subjects who were 1-year post-fracture repair completed 1-year questionnaires (20 withdrew consent/were lost to follow-up, and 6 were mentally/physically unable to participate). There was no statistically significant difference in number of adverse events/severe adverse events between socially isolated and non-socially isolated subjects. There was also no difference in LEAS score or any PROMIS-29 domain between isolated and non-isolated subjects 1 year after surgery. However, socially isolated patients were more likely to improve their LSNS-18 score than those who were not socially isolated prior to fracture repair (Δ6.1 ±13.3 vs. Δ-1.2 ±13.7; p=0.03).

Conclusion:

There is a trend suggesting social isolation may be associated with 1-year mortality in cognitively intact elderly patients undergoing surgical repair of low energy hip fracture. Although there was no association between pre-fracture social isolation and adverse events or self-reported patient reported outcomes, on average socially isolated patients were less isolated 1 year after fracture repair than pre-fracture. Whether the magnitude of improvement in social isolation is associated with improved health status will be evaluated as this study continues to recruit.

« Back to 2018 ACR/ARHP Annual Meeting

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